Pilot Study of Combined Treatment for Veterans with Chronic Pain & Opiate Misuse

描述（由申请人提供）：阿片类药物处方用于治疗慢性疼痛是常见的，并且伴随着治疗结果不佳的风险，以及临床显著数量患者的较高发病率和死亡率，特别是那些符合标准或阿片类药物依赖的患者。尽管处方阿片类药物误用、滥用和依赖在美国全国范围内出现了惊人的增长（从1992年到2003年增长了140%），但在慢性疼痛患者中，针对疼痛相关干扰和阿片类药物依赖的治疗选择很少。在退伍军人中，这一问题尤为重要，因为许多报告表明，在治疗慢性疼痛方面，阿片类药物的使用越来越多，与阿片类药物相关的问题也越来越多，特别是在伊拉克和阿富汗战区服役的退伍军人[持久自由行动（OEF），伊拉克自由行动（OIF）和新黎明行动（OND）]。迄今为止，还没有基于证据的治疗方案，旨在最大限度地提高慢性疼痛退伍军人的有效功能，同时解决阿片类药物使用问题。本研究的总体目的是确定对患有慢性疼痛的退伍军人进行综合心理治疗的可行性。

DESCRIPTION (provided by applicant): Opioid prescription in the treatment of chronic pain is frequent and carries a consequent risk of poor treatment outcome, as well as higher morbidity and mortality in a clinically significant number of patients, particularly those who meet criteria or opioid dependence. Despite the alarming increases (140% increase from 1992 to 2003) in prescription opiate misuse, abuse, and dependence nationally in the United States, there are few treatment options available that target both pain-related interference and opioid dependence among patients with chronic pain. In military veterans, this issue is of particular importance as numerous reports indicate increasing use of opioids in the treatment of chronic pain, as well as increasing opioid-related problems, specifically in those who served in the Iraq and Afghanistan theatres [Operation Enduring Freedom (OEF), Operation Iraqi Freedom (OIF), and Operation New Dawn (OND)]. To date, there are no evidenced-based treatment options which aim to both maximize effective functioning in Veterans with chronic pain while simultaneously addressing problematic opioid use. The overall aim of the present study will be to determine the feasibility of an integrated psychosocial treatment in veterans with chronic pain, who also have evidence of opioid-related misuse. To examine this aim, we will utilize a randomized design to assess the feasibility of integrating two empirically supported interventions: Acceptance and Commitment Therapy for chronic pain and Mindfulness Based Relapse Prevention for substance use and misuse. Feasibility will be assessed by examining rates of recruitment and retention of participants through a six month follow-up. In addition, we will evaluate progress within-treatment on specific therapy targets to aid in the identification of potential treatment mechanisms. The results of this study will directly inform treatment of chronic pain patients and represents a significant advance in the growing and understudied problem of opiate misuse among chronic pain patients. In addition to addressing the question of whether the treatment is feasible, it will further examine issues of treatment mechanisms to better inform the design of a randomized and controlled trial assessing treatment efficacy.