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

退伍军人慢性疼痛综合治疗试点研究

• 批准号: 8899446
• 负责人: KEVIN E VOWLES
• 金额: $ 20.91万
• 依托单位: UNIVERSITY OF NEW MEXICO
• 依托单位国家: 美国
• 财政年份: 2014
• 资助国家: 美国
• 起止时间: 2014-08-01 至 2017-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8899446
• 关键词: Address; Afghanistan; Alcohol or Other Drugs use; Behavior Therapy; Combined Modality Therapy; Compassion; Complex; Data; Dependence; Distress; Drops; Evidence based treatment; Freedom; Goals; Health; High Prevalence; Hospitals; Human; Intervention; Iraq; Knowledge; Measures; Military Personnel; Modeling; Morbidity - disease rate; National Center for Complementary and Alternative Medicine; National Institute of Drug Abuse; Opiate Addiction; Opiates; Opioid; Pain; Pain interference; Participant; Patients; Pilot Projects; Population; Process; Public Health; Randomized; Randomized Clinical Trials; Randomized Controlled Trials; Recruitment Activity; Reporting; Risk; Sample Size; Specific qualifier value; Theoretical model; Therapeutic; Treatment Efficacy; Treatment outcome; United States; United States Department of Veterans Affairs; Value of Life; Veterans; Work; base; chronic pain; clinically significant; craving; design; disability; disorder later incidence prevention; efficacy testing; evidence base; follow-up; improved; innovation; meetings; mindfulness; mortality; operation; opioid misuse; prescription opiate; prescription opioid; psychosocial; standard care; targeted treatment

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.

描述（由申请人提供）：慢性疼痛治疗中的阿片类药物处方经常出现，因此具有不良治疗结果的风险，以及临床上大量患者，尤其是符合标准或阿片类药物依赖性的患者的发病率和死亡率更高。尽管在美国，在全国范围内的滥用，滥用和依赖性的处方滥用，滥用和依赖性增加了140％（从1992年到2003年增加了140％），但慢性疼痛患者的治疗方案几乎没有针对与疼痛相关的干扰和阿片类药物依赖性。在退伍军人中，此问题尤其重要，因为许多报告表明，阿片类药物在治疗慢性疼痛方面的使用越来越多，并且增加了与阿片类药物有关的问题，特别是在伊拉克和阿富汗剧院服务的人[持久自由（OEF），IRAQI Freedom（OIF（OIF）和Operation of New Dawn Dawn（On New Dawn）（On Dawn Dawn）（On Dawn Dawn（Ond））。迄今为止，还没有基于证据的治疗方案，既旨在最大程度地提高慢性疼痛的退伍军人，同时解决有问题的阿片类药物使用情况。本研究的总体目的是确定慢性疼痛的退伍军人的综合心理社会治疗的可行性， 他也有与阿片类药物有关的滥用的证据。为了检查这一目标，我们将利用一种随机设计来评估整合两种经验支持的干预措施的可行性：用于慢性疼痛和基于正念的预防物质使用和滥用的慢性疼痛和正念复发的疗法。可行性将通过检查参与者的招聘率和保留六个月的随访来评估。此外，我们将评估有关特定治疗靶标的进度，以帮助识别 潜在的治疗机制。这项研究的结果将直接告知对慢性疼痛患者的治疗，这代表了慢性疼痛患者的鸦片滥用问题的增长和研究的重大进展。除了解决治疗是否可行的问题外，还将进一步研究治疗机制的问题，以更好地为一项评估治疗功效的随机和对照试验的设计提供信息。