Treating Chronic Pain in Buprenorphine Patients in Primary Care Settings

描述（由申请人提供）：近50万美国人接受丁丙诺啡治疗阿片类药物依赖。在寻求丁丙诺啡治疗的患者中，约有40%的患者存在疼痛，这种疼痛干扰了日常活动，影响了药物治疗效果，但目前还没有有效的非药物治疗方法来改善疼痛结果。在阿片类药物依赖患者中，疼痛通常与抑郁症同时发生，这使得开发一种新的疼痛治疗方法变得复杂。该项目将开发一种协作治疗，行为健康专家（BHS：社会工作者、护士、心理学家）和初级保健提供者（pcp）共享一个统一的计划，以解决在办公室环境中接受丁丙诺啡的患者的疼痛和抑郁问题。这种名为TOPPS（治疗阿片类药物患者的痛苦和悲伤）的合作疗法建立在行为疗法的基础上，旨在减少行为回避和增加行为激活。具体目标的实现将分两个阶段进行。首先，我们将进行迭代开放

DESCRIPTION (provided by applicant): Nearly half a million Americans receive buprenorphine for opioid dependence treatment. Approximately 40% of those seeking treatment with buprenorphine have pain that interferes with daily activities and affects drug treatment outcomes, yet no effective non-pharmacological therapies exist to improve pain outcomes. Developing a novel pain treatment is complicated by the fact that among opioid dependent patients, pain often co-occurs with depression. This project will develop a collaborative treatment, in which behavioral health specialists (BHS: social workers, nurses, psychologists) and primary care providers (PCPs) share a unified plan for addressing pain and depression in patients receiving buprenorphine in office-based settings. This collaborative therapy, entitled TOPPS (Treating Opioid Patients' Pain And Sadness), builds upon behavior therapy that targets a reduction in behavioral avoidance and an increase in behavioral activation. Achievement of the Specific Aims will occur in the context of two phases. First, we will conduct an iterative open trial of TOPPS (n=15). Next, we will conduct a pilot randomized clinical trial (n=40) with two treatment arms, TOPPS and Health Education. Pain will be the primary outcome variable assessed, and depression and illicit substance use will be the secondary outcome variables. The Aims of this project are: 1. To develop and refine TOPPS so that it meets standards of feasibility and acceptability for primary care physicians (PCPs), behavioral health specialists (BHSs), and participants (open trial and pilot RCT); a. To develop, field-test, and finalize a TOPPS manual; b. To develop a reliable measure of BHS adherence to the manual; c. To develop, field-test, and finalize BHS training and supervision procedures; 2. To refine research procedures (e.g., consent process, randomization process, and assessment procedures), and establish their feasibility and acceptability to participants (pilot RCT) while confirming recruitment goal targets. This line of work could lead to the incorporation into buprenorphine care of theoretically-driven and effective mental health treatment for patients with pain and depression. This would be the first empirically-tested therapy protocol that specifically integrate treatment of these conditions in substance abuse research. We believe that this treatment will lead to improved pain, depression, and substance abuse outcomes.