Adapting Web-based CBT to improve adherence and outcome for individuals with opioid use disorder and chronic pain treated with opioid agonists

慢性疼痛在接受阿片类激动剂治疗的患者中很常见(燕麦； 丁丙诺啡或美沙酮)，并与较差的阿片使用障碍(OUD)有关 结果，包括更高的自然减员和更高的药物使用水平。慢性疼痛的治疗 服用燕麦片的个体是复杂的，因为慢性疼痛的存在与 精神障碍以及睡眠问题和其他问题的频率更高 可能会导致较差结果的并存。考虑到大量的个体 慢性疼痛寻求燕麦片、标准化、低成本和易于传播的方法 治疗燕麦片中有慢性疼痛的个人是必要的，如果证明是这样的话 在这一人群中有效，将具有很高的公共卫生意义。 为了响应RFA-AT-19-006，我们计划开发和试运行一种基于Web的集成 认知行为方法(R61阶段)，然后进行随机临床试验 评估其相对于标准护理的疗效，对患有以下疾病的大样本患者进行评估 丁丙诺啡或美沙酮治疗慢性疼痛(R33期)。新计划将 保留卡罗尔博士认知行为疗法的计算机培训的关键部分 (CBT4CBT)，包括强调在 参与方式并专注于MAT的5个A(坚持、出勤、节制、替代 活动和访问支持)；它将添加来自希皮博士的COPS的组件 (合作疼痛教育和自我管理)干预(慢性病患者的自我管理 疼痛，通过IVR监测疼痛强度和干扰、体力活动和技能练习) 并修改现有的CBT4CBT模块，以解决Pain和 在这一人群中使用药物，强调普遍技能的发展。在R33公路上 阶段，我们将进行一项随机临床试验，评估CBT4CBT-COPS在不同的 参加激动剂治疗(美沙酮或丁丙诺啡)的160人样本 慢性疼痛，在为期3个月的随机临床试验中，并进行6个月的随访，将其与 单独的标准治疗。主要保留结果将是与激动剂的依从性 治疗；主要的疼痛结果将是PROMIS 6项疼痛干预缩写形式。

Chronic pain is common among individuals treated with opioid agonist therapies (OAT; buprenorphine or methadone) and is associated with poorer opioid use disorder (OUD) outcomes, including higher attrition and higher levels of drug use. Treatment of chronic pain in individuals who are maintained on OAT is complex, as presence of chronic pain is associated with greater frequency of psychiatric disorders as well as sleep problems and other comorbidities that can contribute to poorer outcomes. Given the large number of individuals with chronic pain seeking OAT, standardized, lower-cost, and easily disseminable approaches to treat individuals in OAT who have chronic pain are needed and, if demonstrated to be effective in this population, would have high public health significance. In response to RFA-AT-19-006, we plan to develop and pilot test an integrated, web-based cognitive behavioral approach (R61 phase), and then conduct a randomized clinical trial evaluating its efficacy relative to standard care in a large and diverse sample of individuals with chronic pain treated with buprenorphine or methadone (R33 phase). The new program will retain key components of Dr. Carroll’s computer-based training for cognitive-behavioral therapy (CBT4CBT), including its emphasis on teaching cognitive and behavioral coping skills in an engaging way and focus on the 5 A’s of MAT (Adherence, Attendance, Abstinence, Alternate Activities and Accessing support); it will add components from Dr. Heapy’s COPES (Cooperative Pain Education and Self-Management) intervention (self-management of chronic pain, with IVR monitoring of pain intensity and interference, physical activity, and skills practice) and modify existing CBT4CBT modules to address the complex interplay between pain and drug use in this population, emphasizing the development of generalizable skills. In the R33 phase, we will conduct a randomized clinical trial evaluating CBT4CBT-COPES in a diverse sample 160 of individuals enrolled in agonist treatment (methadone or buprenorphine) who have chronic pain, in a 3-month randomized clinical trial with a 6-month follow-up, comparing it to standard treatment alone. The primary retention outcome will be adherence with agonist treatment; the primary pain outcome will be the PROMIS 6-item Pain Interference Short Form.