Treatment of Opioid Dependence and Chronic Pain

描述(由申请人提供)：项目摘要：这是2006年7月首次审查的一项申请的重新提交。这项K23指导的以患者为导向的研究职业发展奖将允许临床心理学家詹妮弗·波特博士接受治疗慢性疼痛和阿片依赖的高级培训，以便对共生的慢性疼痛和阿片依赖进行与治疗相关的研究。这一职业发展计划的具体目标是：1)获得慢性疼痛治疗和评估方面的高级培训；2)更好地了解纵向研究和临床试验的设计和统计分析；3)进一步了解阿片类药物依赖治疗；4)探索阿片类药物依赖和慢性疼痛的综合心理社会治疗；以及5)获得负责任的研究行为方面的高级培训，包括与慢性疼痛相关的伦理问题。波特博士将由她的赞助人罗杰·韦斯医学博士以及三位共同赞助人大卫·博尔苏克、罗伯特·贾米森博士和加勒特·菲茨莫里斯医学博士指导。这项拟议研究的主要目标是在形成性研究的基础上，开发一种针对阿片类药物依赖和慢性疼痛的综合心理社会疗法。具体目标1将检验这一假设，即患有慢性疼痛和阿片类药物依赖的人与没有慢性疼痛的人不同，他们的物质滥用有特定的身体、情感和情景先兆。具体目标2将检验这一假设，即慢性疼痛相关因素预测阿片依赖治疗后非法阿片类药物的使用。具体目标3是开发和测试认知-行为机械化治疗阿片类药物依赖和慢性疼痛共存的可行性和可接受性。为了实现这些目标，我提出了一系列与培训活动相一致的三项研究。最初两项研究中涉及的具体目标1和2将为研究中审查的具体目标3提供信息。前两项研究的结果将指导循证治疗策略的选择和必要时原始治疗策略的发展。 公共卫生相关性：现有文献表明，阿片类药物依赖和慢性疼痛共同出现是常见的。患有这两种疾病的个人的具体治疗需求没有得到很好的描述。这项建议审查了这一人群的治疗需求，并开发了一种心理社会干预措施来解决这些需求。

DESCRIPTION (provided by applicant): Project Summary: This is a resubmission of an application reviewed initially in July 2006. This K23 Mentored Patient-Oriented Research Career Development Award will permit, Dr. Jennifer Potter, a clinical psychologist, to obtain advanced training in the treatment of chronic pain and opioid dependence in order to conduct treatment-related research on co-occurring chronic pain and opioid dependence. The specific aims of this career development plan are to: 1) obtain advanced training in chronic pain treatment and assessment; 2) develop a greater understanding of the design and statistical analysis of longitudinal studies and clinical trials; 3) acquire further knowledge of opioid dependence treatment; 4) explore integrated psychosocial treatment for co-occurring opioid dependence and chronic pain; and 5) obtain advanced training in responsible conduct of research including ethical issues related to chronic pain. Dr. Potter will be guided by her sponsor, Roger Weiss, M.D., and three co-sponsors, David Borsook, M.D., Robert Jamison, Ph.D., and Garrett Fitzmaurice, Sc.D. The primary objective of the proposed research is to develop an integrated psychosocial treatment for co-occurring opioid dependence and chronic pain based on formative research. Specific Aim 1 will test the hypothesis that individuals with co-occurring chronic pain and opioid dependence have specific physical, emotional, and situational antecedents for their substance misuse distinct from individuals without chronic pain. Specific Aim 2 will test the hypothesis that chronic pain-related factors predict illicit opioid use following treatment for opioid dependence. Specific Aim 3 is to develop and test the feasibility and acceptability of a cognitive-behavioral manualized treatment for co-occurring opioid dependence and chronic pain. To accomplish these aims, I propose a series of three studies sequenced to coincide with training activities. Specific Aims 1 and 2, addressed in the initial two studies, will inform Specific Aim 3 examined in the study. Findings from the first two studies will guide selection of evidence-based treatment strategies and development of original treatment strategies as necessary. PUBLIC HEALTH RELEVANCE: Existing literature suggests that co-occurring opioid dependence and chronic pain are common. Specific treatment needs of individuals with both conditions are not well characterized. This proposal examines treatment needs within this population and develops a psychosocial intervention to address them.