Improving Pain Management and Opioid Safety for Patients with Cirrhosis

处方阿片类药物是阿片类药物相关死亡的主要原因，对患者来说尤其危险 患有肝硬变。美国有400万人患有肝硬变，最常见的原因是酒精或药物 使用障碍(SUD)介导的丙型肝炎在这一人群中，处方阿片类药物与减少 获得挽救生命的移植以及增加肝病并发症、住院和 死亡率。尽管存在这些风险，但约有一半的肝硬变患者服用阿片类药物。 每年。这可能是因为80%的肝硬变患者有慢性疼痛和交替疼痛。 管理策略还没有针对这一人群设计或测试。的确，现有的痛苦 为普通人群设计的管理干预措施不能解决面临的许多具体问题 肝硬变患者总体症状负担大，禁忌症最常见的止痛药 药物，以及潜在的精神健康和肥皂水。国家疼痛战略建议使用 行为干预，特别是疼痛自我管理干预，以解决慢性疼痛。然而， 当这些干预措施旨在满足人口的特定需求时，它们是最有效的 感兴趣的人。因此，这个K23奖项的首要研究目标是开发和测试一种行为 对肝硬变患者慢性疼痛的干预。这一目标将通过以下具体措施实现 目的：1)开发一种以理论为基础的行为干预措施，以改善患者的疼痛和功能 以及Aim 2)对在Aim 1中开发的干预措施进行随机先导试验。 自我管理干预将作为这项工作的起点。遵循以下既定步骤 干预映射(IM)，一种开发基于理论的行为干预的结构化方法， 利益相关者的意见和半结构化访谈将被整合到针对疼痛的行为干预中 满足肝硬变患者的需求。由此产生的干预措施将在40名患有 肝硬变和慢性疼痛。这项研究具有重要意义，因为它旨在解决全国阿片类药物危机 高危、研究不足的人群。此外，这种方法可能适用于其他具有 慢性疼痛和肥皂水的比率很高。这项研究具有创新性，因为它将导致首次干预 对这些人来说是痛苦的。Shari Rogal博士是进行这项研究的得天独厚的人选，因为她是 胃肠病学家和移植肝病学家，专注于肥皂和疼痛的研究 肝脏疾病的背景。通过这一奖项，罗格尔博士将接受更多关于慢性疼痛科学的培训， 行为科学和行为临床试验，以及多学科指导团队的支持。 因此，K23将使她能够发展独立的研究事业，成为开发、测试和 对具有复杂医疗、心理健康和物质的患者实施慢性疼痛干预 使用合并症。

Prescription opioid medications are a leading cause of opioid-related death and are particularly risky in patients with liver cirrhosis. Cirrhosis affects four million people in the US and is most often due to alcohol or substance use disorder (SUD)-mediated hepatitis C. In this population, prescription opioids are associated with decreased access to life-saving transplantation and increased complications of liver disease, hospitalizations, and mortality. Despite these risks, approximately half of all patients with cirrhosis are prescribed opioid medications each year. This is likely because 80% of patients with cirrhosis have chronic pain and alternative pain management strategies have not been designed for or tested in this population. Indeed, existing pain management interventions designed for general populations do not address many of the specific issues facing patients with cirrhosis such as their overall high symptom burden, contraindications to most common analgesic medications, and underlying mental health and SUDs. The National Pain Strategy recommends using behavioral interventions, specifically pain self-management interventions, to address chronic pain. However, such interventions are most effective when they are designed to address the specific needs of the population of interest. Therefore, the overarching research goal of this K23 award is to develop and test a behavioral intervention for chronic pain for patients with cirrhosis. This goal will be achieved through the following Specific Aims: Aim 1) To develop a theory-based behavioral intervention to improve pain and function for patients with cirrhosis; and Aim 2) To conduct a randomized pilot trial of the intervention developed in Aim 1. Existing pain self-management interventions will serve as a starting point for this work. Following the established steps of Intervention Mapping (IM), a structured approach to developing theory-based behavioral interventions, stakeholder input and semi-structured interviews will be integrated into a behavioral intervention for pain that addresses the needs of patients with cirrhosis. The resulting intervention will be pilot tested in 40 patients with cirrhosis and chronic pain. This research is significant because it aims to address the national opioid crisis in a high-risk, understudied population. Furthermore, this approach may be applicable to other populations with high rates of chronic pain and SUDs. This research is innovative because it will lead to the first intervention for pain for this population. Dr. Shari Rogal is uniquely positioned to conduct this study, as she is a gastroenterologist and transplant hepatologist with a research focus on studies of SUDs and pain in the context of liver disease. Through this award Dr. Rogal will receive additional training in chronic pain science, behavioral science, and behavioral clinical trials, as well as the support of a multidisciplinary mentoring team. This K23 will thus allow her to develop an independent research career as a leader in developing, testing, and implementing interventions for chronic pain in patients with complex medical, mental health, and substance use comorbidities.