Enhancing the impact of behavioral pain management on MAT outcomes

项目总结/摘要 为了解决美国的阿片类药物流行病，必须改善个人的结果 阿片类药物使用障碍（OUD）。药物辅助治疗（MAT）对那些 OUD患者，但MAT的治疗保留较差，降低了这些干预措施的潜在积极影响。 一个与OUD患者预后较差有关的因素可能会破坏治疗 坚持是慢性疼痛，这是在大多数接受OUD治疗的患者中报告的。心理社会 疼痛干预措施对慢性疼痛和物质使用障碍患者有效，但这些 在接受MAT的OUD人群中，尚未彻底检查干预措施。研究团队 最近收到了国家补充和综合健康中心的一笔赠款， 通过电话为OUD患者提供心理社会疼痛管理干预（PPMI） 接收MAT。在最终确定干预措施后，该资助研究将进行随机试验（N=100） 将基于电话的PPMI方法与EUC进行比较，以评估PPMI随机化对MAT的影响 保留，疼痛水平，疼痛相关功能和阿片类药物使用频率。然而，还需要做更多的工作， 了解这种干预措施对其他高危人群的潜在适用性，研究其长期影响， 并收集数据，为MAT患者实施PPMI提供信息。特别是，理解 接触退伍军人的方法很重要，因为有一致的证据表明， OUD和阿片类药物相关的不良事件，包括过量，退伍军人。拟议的工作涉及 文献中的空白，并通过以下方式在正在进行的供资项目基础上再接再厉：（目标1）增加更多的招募地点 在VA安阿伯医疗保健系统（100名额外参与者或当与 （目标2）通过增加后续评估，扩大长期结果的衡量 在6个月、9个月和12个月时对整个样本（N=200）进行评估;（目标3）通过以下方式促进结果的快速实施 收集关键利益相关者的定性数据，包括MAT治疗提供者（N=15）和 接受PPMI干预（在试验结束时招募的N=20名参与者）。这项工作将提供 对PPMI干预进行强有力的测试，以帮助在更大、更具代表性的群体中提高MAT结果 同时也为今后采取干预措施提高MAT成绩铺平了道路。

Project Summary/Abstract In order to address the opioid epidemic in the United States, it is essential to improve outcomes in individuals with opioid use disorders (OUD). Medication Assisted Treatments (MAT) can be extremely helpful for those with OUDs but poor treatment retention on MAT diminishes the potential positive impact of these interventions. One factor that has been linked to poorer outcomes in those with OUD and may undermine treatment adherence is chronic pain, which is reported in the majority of those receiving OUD treatment. Psychosocial interventions for pain have been effective in patients with chronic pain and substance use disorders, but these interventions have not been thoroughly examined in the OUD population receiving MAT. The study team received a recent grant from the National Center for Complementary and Integrative Health to refine and adapt a psychosocial pain management intervention (PPMI) to be delivered by telephone for patients with OUD receiving MAT. After finalizing the intervention this funded study will conduct a randomized trial (N=100) comparing telephone-based PPMI approach to EUC to assess the impact of randomization to PPMI on MAT retention, pain level, pain-related functioning, and frequency of opioid use. However, more work is needed to understand the potential applicability of this intervention to other high-risk groups, study the longer-term impact of PPMI and gather data to inform the implementation of PPMI in MAT patients. In particular, understanding methods to reach Veterans is important because of consistent evidence highlighting the high prevalence of OUDs and opioid-related adverse events, including overdose, in Veterans. The proposed work addresses the gaps in the literature and builds on the ongoing, funded project by: (aim 1) adding additional recruitment sites at the VA Ann Arbor Healthcare System (100 additional participants or a total N of 200 when combined with the ongoing study); (aim 2) extending the measurement of longer-term outcomes by adding follow-up assessments at 6-, 9- and 12-months for the entire sample (N=200); (aim 3) facilitating the rapid implementation of results by gathering qualitative data from key stakeholders including MAT treatment providers (N=15) and patients who received the PPMI intervention (N=20 participants recruited at the end of the trial). This work will provide a robust test of the PPMI intervention to help enhance MAT outcomes in a larger and more-representative group of participants while also paving the way for future implementation of interventions to improve MAT retention.