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

描述(申请人提供)：阿片类药物处方在治疗慢性疼痛中经常出现，因此存在治疗结果不佳的风险，以及在临床上大量患者中较高的发病率和死亡率，特别是那些符合标准或阿片类药物依赖的患者。尽管美国全国范围内处方阿片滥用、滥用和依赖的增加令人震惊(从1992年到2003年增加了140%)，但针对慢性疼痛患者的疼痛相关干预和阿片依赖的治疗方案很少。对于退伍军人来说，这个问题特别重要，因为许多报告表明，阿片类药物越来越多地用于治疗慢性疼痛，并增加了与阿片类药物有关的问题，特别是在那些曾在伊拉克和阿富汗战区服役的人[持久自由行动、伊拉克自由行动和新黎明行动]。到目前为止，还没有基于证据的治疗方案，旨在最大化患有慢性疼痛的退伍军人的有效功能，同时解决有问题的阿片类药物使用问题。本研究的总体目标是确定对患有慢性疼痛的退伍军人进行综合心理社会治疗的可行性， 他们也有阿片类药物滥用的证据。为了检验这一目标，我们将利用随机设计来评估整合两种经验支持的干预措施的可行性：针对慢性疼痛的接受和承诺疗法，以及针对物质使用和误用的基于正念的复发预防。将通过六个月的后续行动审查参与者的招聘和留存率，以评估其可行性。此外，我们将评估特定治疗目标的治疗内进展，以帮助确定 潜在的治疗机制。这项研究的结果将直接为慢性疼痛患者的治疗提供信息，并代表着在慢性疼痛患者中日益增长且未得到充分研究的阿片类药物滥用问题上的重大进展。除了解决治疗是否可行的问题外，它还将进一步审查治疗机制的问题，以便更好地为评估治疗效果的随机对照试验的设计提供信息。

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.