Improving Sleep and Reducing Opioid Use in Individuals with Chronic Pain

改善慢性疼痛患者的睡眠并减少阿片类药物的使用

基本信息

  • 批准号:
    10587972
  • 负责人:
  • 金额:
    $ 66.41万
  • 依托单位:
  • 依托单位国家:
    美国
  • 项目类别:
  • 财政年份:
    2023
  • 资助国家:
    美国
  • 起止时间:
    2023-08-01 至 2028-05-31
  • 项目状态:
    未结题

项目摘要

PROJECT SUMMARY Opioid therapy is commonly prescribed for patients with chronic widespread musculoskeletal pain, but offers questionable benefit for long-term pain management and is associated with arrhythmias, overdose, and death. Individuals with chronic pain experience high rates of comorbid chronic insomnia, arousal, and abnormal brain activation in response to painful stimuli. Research shows individuals with chronic pain exhibit increased brain activation in regions associated with pain modulation in response to painful stimuli compared to healthy controls. Withdrawal from opioids is difficult; and inadequately managed pain contributes to that difficulty. The Cognitive Activation Theory of Stress (CATS) tests the hypothesis that poor sleep and arousal lead to critical changes in brain activation that increase pain severity and lead to opioid use. Research shows cognitive behavioral treatment for insomnia (CBT-I, an evidence based intervention for chronic insomnia) improves sleep, arousal, abnormal brain activation, and pain in individuals with comorbid chronic pain and insomnia, but does not reduce opioid use. However, because CBT-I improves each of the mediators hypothesized to contribute to opioid use, it warrants examination as a neoadjuvant to gradual tapering of opioid medication. The proposed trial tests the novel hypothesis that improving sleep and decreasing arousal will lead to normalized brain activation and decreased pain prior to gradual tapering, which will facilitate reduced opioid use. This hypothesis is supported by theory (CATS) and empirical findings. It also reflects federal pain research priorities. Trial Design. 165 adults who use prescription opioid users (18+ years of age) and have chronic pain and insomnia will be randomized to CBT-I or Sleep Hygiene and Related Education (SHARE). They will then undergo a gradual tapered withdrawal protocol for opioids. Outcomes (sleep, arousal, brain activation, pain, opioid use, opioid related problems) will be examined at baseline (BL), post intervention (P1), post withdrawal (P2), and 6-month follow-up. Specific Aims 1 and 2 test the impact of CBT-I on sleep, arousal, brain activation, pain, opioid use, and opioid related problems compared to the active SHARE control. Specific Aims 3 and 4 test the impact of tapering opioid use following CBT-I on sleep, arousal, brain activation, pain, opioid use, and opioid related problems compared to the combined SHARE and tapered withdrawal control. An Exploratory Aim examines the relationships between changes in the mechanistic outcomes and changes in the opioid outcomes, and their potential moderators (e.g., craving, withdrawal symptoms, sex, age, race, ethnicity). Public Health Implications: Demonstration that a relatively brief behavioral sleep intervention facilitates tapered withdrawal from opioid medication and protects against relapse through improvements in sleep, arousal, abnormal brain activation, and pain has important implications for the millions of individuals living with chronic pain, their families, communities, and healthcare.
项目总结

项目成果

期刊论文数量(0)
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Christina S McCrae其他文献

Christina S McCrae的其他文献

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{{ truncateString('Christina S McCrae', 18)}}的其他基金

Web-based CBT for Insomnia in Rural Dementia Caregivers: Examination of Sleep, Arousal, Mood, Cognitive, and Immune Outcomes
针对农村痴呆症护理人员失眠的基于网络的 CBT:睡眠、觉醒、情绪、认知和免疫结果的检查
  • 批准号:
    10610439
  • 财政年份:
    2021
  • 资助金额:
    $ 66.41万
  • 项目类别:
Contributions of Sleep and Pain to Alzheimer's Disease Related Biomarkers: Identifying Modifiable Risk Factors in Women with Normal to Mildly Impaired Cognitive Function
睡眠和疼痛对阿尔茨海默病相关生物标志物的影响:识别认知功能正常至轻度受损女性的可改变危险因素
  • 批准号:
    10289504
  • 财政年份:
    2021
  • 资助金额:
    $ 66.41万
  • 项目类别:
Web-based CBT for Insomnia in Rural Dementia Caregivers: Examination of Sleep, Arousal, Mood, Cognitive, and Immune Outcomes
针对农村痴呆症护理人员失眠的基于网络的 CBT:睡眠、觉醒、情绪、认知和免疫结果的检查
  • 批准号:
    10739134
  • 财政年份:
    2021
  • 资助金额:
    $ 66.41万
  • 项目类别:
Web-based CBT for Insomnia in Rural Dementia Caregivers: Examination of Sleep, Arousal, Mood, Cognitive, and Immune Outcomes
针对农村痴呆症护理人员失眠的基于网络的 CBT:睡眠、觉醒、情绪、认知和免疫结果的检查
  • 批准号:
    10428576
  • 财政年份:
    2021
  • 资助金额:
    $ 66.41万
  • 项目类别:
Impact of CBT for Insomnia on Pain Symptoms and Central Sensitization in Fibromyalgia.
CBT 治疗失眠对纤维肌痛疼痛症状和中枢敏化的影响。
  • 批准号:
    10163918
  • 财政年份:
    2018
  • 资助金额:
    $ 66.41万
  • 项目类别:
Impact of CBT for Insomnia on Pain Symptoms and Central Sensitization in Fibromyalgia.
CBT 治疗失眠对纤维肌痛疼痛症状和中枢敏化的影响。
  • 批准号:
    10414802
  • 财政年份:
    2018
  • 资助金额:
    $ 66.41万
  • 项目类别:
Impact of CBT for Insomnia on Pain Symptoms and Central Sensitization in Fibromyalgia.
CBT 治疗失眠对纤维肌痛疼痛症状和中枢敏化的影响。
  • 批准号:
    9769887
  • 财政年份:
    2018
  • 资助金额:
    $ 66.41万
  • 项目类别:
Impact of CBT for Insomnia on Pain Symptoms and Central Sensitization in Fibromyalgia.
CBT 治疗失眠对纤维肌痛疼痛症状和中枢敏化的影响。
  • 批准号:
    9927672
  • 财政年份:
    2018
  • 资助金额:
    $ 66.41万
  • 项目类别:
Sleep and Pain Interventions in Fibromyalgia: Hyperalgesia and Central Sensitizat
纤维肌痛的睡眠和疼痛干预:痛觉过敏和中枢敏化
  • 批准号:
    7941684
  • 财政年份:
    2009
  • 资助金额:
    $ 66.41万
  • 项目类别:
Sleep in Cardiac patients with Implantable Cardioverter Defibrillators (ICD)
使用植入式心脏复律除颤器 (ICD) 的心脏病患者的睡眠
  • 批准号:
    7839764
  • 财政年份:
    2009
  • 资助金额:
    $ 66.41万
  • 项目类别:

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