Psychosocial pain management during addictions treatment to improve outcomes

描述（由申请人提供）：物质使用障碍（sud）患者的慢性疼痛是一个常见且非常重要的问题，很少得到适当的管理。在接受SUD治疗的患者中，慢性疼痛的估计发生率高达60%，许多患者报告在治疗期间持续且明显的疼痛。由于许多处方止痛药可能被滥用和转移，患有sud的患者的疼痛治疗很复杂。此外，最近的证据表明，未经治疗的疼痛可能会破坏对sud的标准治疗的有效性。一个重要的潜在策略是使用认知行为疗法（CBT）来管理疼痛和减少药物使用/滥用。社会心理干预，如认知行为治疗，已经证明对患有广泛疼痛相关问题的人减轻疼痛和改善功能有效，但尚未对患有sud的人进行评估。因此，SUD治疗提供者没有成功的和经验支持的方法来治疗大量同时患有SUD的慢性疼痛患者。该研究是一项随机对照疗效试验，将CBT治疗疼痛和SUD与支持性心理教育控制（SPC）组相结合，对合并慢性疼痛的SUD患者进行分组干预。共有452名患者（226名男性和226名女性）目前的疼痛等级为中度或更高，将从一家大型住宅SUD治疗机构中招募。这些参与者将被随机分配到一个为期4周（8个疗程）的疼痛和sud综合CBT组或一个为期4周（8个疗程）的SPC组。所有参与者将在干预结束后（约1个月）以及干预后3个月、6个月和12个月进行重新评估。主要的具体目标将侧重于疼痛（程度、耐受性和与疼痛有关的残疾）和物质使用（药物、酒精和阿片类药物滥用的频率）结果。二级分析将探讨：1)干预期间疼痛的改变是否介导CBT对随后物质使用/滥用的影响；2) CBT干预的其他假设作用机制；3)干预对HIV危险行为和抑郁症状的影响。混合模型回归分析将用于所有主要目的，在每个性别中，估计组间随时间变化的结果差异。目前，治疗提供者缺乏基于证据的干预措施来解决sud患者的疼痛问题。改善对sud患者疼痛的治疗不仅会对个人疼痛产生广泛的影响，还会对他们的药物使用和生活质量产生影响。在拟议的研究中产生的知识可能对许多不同医疗保健机构中疼痛和sud患者的护理具有广泛的意义。

DESCRIPTION (provided by applicant): Chronic pain among individuals with Substance Use Disorders (SUDs) is a common and critically important problem that is rarely managed appropriately. The estimated rates of chronic pain in patients who are in SUD treatment are as high as 60 percent, with many patients reporting long-lasting and significant pain during treatment. The treatment of pain is complicated in those with SUDs because of the potential for abuse and diversion of many prescription pain medications. Furthermore, recent evidence suggests that untreated pain may undermine the effectiveness of standard treatments for SUDs. An important potential strategy is the use of cognitive behavioral therapy (CBT) to both manage pain and decrease substance use/misuse. Psychosocial interventions such as CBT have demonstrated efficacy for reducing pain and improving functioning in persons with a broad spectrum of pain-related problems, but have not been evaluated in those with SUDs. Thus, SUD treatment providers are left without successful and empirically-supported methods for treating the large number of patients with chronic pain who also have SUDs. The proposed study is a randomized controlled efficacy trial of a group-based intervention that integrates CBT for pain and SUDs compared to a Supportive Psychoeducation Control (SPC) group in a sample of patients in SUD treatment with co-occurring chronic pain. A total of 452 patients (226 male and 226 female) with current pain rated as moderate or greater will be recruited from a large residential SUD treatment facility. These participants will be randomly assigned to either a 4-week (8-session) group of integrated CBT for pain and SUDs or a 4-week (8-session) SPC group. All participants will be re-assessed immediately post-intervention completion (around 1-month) and at 3-, 6-, and 12- months after the intervention. The primary specific aims will focus on pain (level, tolerance and pain-related disability) and substance use (frequency of drug, alcohol and opioid medication misuse) outcomes. Secondary analyses will explore: 1) whether change in pain during the intervention mediates the effect of CBT on subsequent substance use/misuse; 2) other hypothesized mechanisms of action for the CBT intervention; and 3) the impact of the intervention on HIV risk behaviors and depressive symptoms. Mixed model regression analyses will be used for all primary aims, within each gender, to estimate between-group differences in changes in outcomes over time. Currently, treatment providers lack evidence-based interventions to address pain in individuals with SUDs. Improving the treatment of pain in patients with SUDs could have a wide-ranging impact not only on individuals' pain, but also on their substance use and quality of life. Knowledge generated in the proposed study is likely to have broad implications for the care of patients with pain and SUDs in many different healthcare settings.