Integrated Care for Chronic Pain and Opioid Use Disorder: The IMPOWR Research Center at Montefiore/Einstein (IMPOWR-ME)

摘要 慢性疼痛（CP）和阿片类药物使用障碍（OUD）是美国发病率和死亡率的主要原因 States.尽管是常见的共病，但人们明显缺乏综合治疗方法 有需要的这对于生活在资源不足地区并寻求护理的黑人和西班牙裔人来说尤其如此。 像纽约州布朗克斯这样的地方，是美国最贫穷和种族最多样化的县之一。 对HEAL倡议的回应：慢性疼痛和OUD的整体恢复综合管理 （IMPOWR）RFA-DA-21-030，本提案的总体目标是在 Montefiore/Einstein（“IMPOWR-ME”），位于纽约布朗克斯的高影响力县。IMPOWR-ME是一种协同 多学科研究中心，利用CP和OUD的卓越研究基础设施， 与CP和OUD患者、倡导者、政策制定者和支付者以及卫生部门的现有关系 系统利益相关者。IMPOWR-ME的目标是：1）创建一个强大的和可持续的研究 基础设施，以严格测试和传播综合和具有成本效益的循证 为患有CP和OUD的人提供实践; 2）与有CP，OUD生活经验的人合作，或 在研究的各个阶段，都有不同的利益相关者; 3）提供机会， 多学科的早期研究者成为专注于CP的独立研究人员， OUD。三个创新的混合1型有效性实施试验提出了严格审查 在不同的卫生保健环境和共病人群中开展多模式循证实践 CP和OUD。具体来说，我们建议：1）在美沙酮现场进行瑜伽和物理治疗的三臂试验 阿片类药物治疗计划，2）一项2x2析因试验，以测试接受和承诺疗法和一项护理 用于基于初级保健的丁丙诺啡治疗的个人的智能手机管理应用程序，以及3）双臂 试验测试微剂量与标准诱导丁丙诺啡住院患者。地参与所有 项目有CP和OUD或阿片类药物滥用，每个项目的具体目标将检查CP，OUD， 实施和成本效益结果;其他以患者为中心的结果将由以下因素驱动： 有生活经验的人。所有这三个项目都改善了黑人和西班牙裔个人获得护理的机会， 通过为他们提供CP和OUD的综合治疗，以及干预措施， 传播和可持续性潜力很大。试点研究的创新计划实现了双重目标 促进由企业家推动的研究，培训早期和新的研究人员。一个杰出的团队 的研究人员和临床专家专注于CP和OUD，与 利益相关者和有生活经验的人，以及高影响力的人群使蒙蒂菲奥里-爱因斯坦成为一个 IMPOWR研究中心的理想场所。

ABSTRACT Chronic pain (CP) and opioid use disorder (OUD) are leading causes of morbidity and mortality in the United States. Despite being commonly comorbid, there is a striking lack of integrated treatments accessible to people in need. This is particularly true for Black and Hispanic individuals living and seeking care in under-resourced settings like The Bronx, NY, one of the poorest and most racially diverse counties in the U.S. Submitted in response to the HEAL Initiative: Integrative Management of Chronic Pain and OUD for Whole Recovery (IMPOWR) RFA-DA-21-030, the overall goal of this proposal is to create the IMPOWR Research Center at Montefiore/Einstein (“IMPOWR-ME”), in the high-impact county of The Bronx NY. IMPOWR-ME is a synergistic multidisciplinary research center that leverages exceptional research infrastructure in CP and OUD and existing relationships with people living with CP and OUD, advocates, policymakers and payers, and health system stakeholders. The aims of IMPOWR-ME are to: 1) create a robust and sustainable research infrastructure to rigorously test and disseminate integrated and cost-effective evidence-based practices for people with CP and OUD; 2) partner with people with lived experience with CP, OUD, or both, and diverse stakeholders in all stages of the research; and 3) provide opportunities for multidisciplinary early stage investigators to become independent researchers focusing on CP and OUD. Three innovative hybrid type 1 effectiveness-implementation trials are proposed to rigorously examine multi-modal evidence-based practices in diverse health care settings and populations of people with comorbid CP and OUD. Specifically, we propose: 1) a three-arm trial of yoga and physical therapy onsite at methadone opioid treatment programs, 2) a 2x2 factorial trial to test Acceptance and Commitment Therapy and a care management smartphone app for individuals in primary-care based buprenorphine treatment, and 3) a two-arm trial to test microdosing vs. standard induction of buprenorphine for hospitalized patients. Participants in all projects have both CP and OUD or opioid misuse, and specific aims for each project will examine CP, OUD, implementation, and cost-effectiveness outcomes; additional patient-centered outcomes will be driven by people with lived experience. All three projects improve access to care for Black and Hispanic individuals in under-resourced settings by bringing integrated treatment of CP and OUD to them, and the interventions have high potential for dissemination and sustainability. An innovative program for pilot studies achieves a dual aim of catalyzing stakeholder-driven research and training early stage and new investigators. An exceptional team of investigators and clinical experts focused on CP and OUD, a longstanding history of collaboration with stakeholders and people with lived experience, and a high-impact population make Montefiore-Einstein an ideal site for an IMPOWR research center.