Integrated Treatment for Veterans with Co-Occurring Chronic Pain and Opioid Use Disorder

项目摘要 慢性疼痛是常见的，昂贵的，和衰弱。阿片类药物治疗慢性 疼痛是经常发生的，并随之带来治疗效果差的风险，以及更高的风险。 在临床上显著数量的患者中，尤其是符合以下条件的患者中， 阿片类药物依赖的标准。尽管滥用处方阿片类药物的情况令人震惊地增加， 阿片类药物使用障碍（OUD）在美国全国范围内，几乎没有治疗选择 现有的针对慢性疼痛患者的疼痛相关干预和OUD的研究。 在退伍军人中，这个问题特别重要，因为许多报告表明， 使用阿片类药物治疗慢性疼痛，以及日益增多的与阿片类药物有关的问题。到 迄今为止，没有循证治疗方案，旨在减少疼痛， 同时解决阿片类药物滥用问题。目前的总体目标是 研究将确定综合心理社会治疗在退伍军人中的疗效， 慢性疼痛，谁正在服用丁丙诺啡治疗OUD。为了实现这一目标，我们 将采用随机设计来评估两种经验支持的干预措施的疗效： 接受和承诺治疗慢性疼痛和正念复发 预防物质使用和滥用。将通过检查疼痛来评估疗效 干预和物质使用的结果后，3个月的积极治疗，以及在6 和12个月随访。次要结局，包括抑郁、疼痛相关恐惧和 阿片类药物滥用风险，也将在这些相同的随访中进行评估。该研究还将审查 治疗机制（包括疼痛）的治疗内变化之间的关系 接受，参与基于价值观的行动，阿片类药物渴望，以及治疗后的变化。 治疗和随访。这项研究的结果将直接告知慢性疼痛的治疗 患者，并代表了一个重大进展，日益增长的和欠研究的问题，OUD 在慢性疼痛患者中。除了解决治疗是否 在可行的情况下，它将进一步审查处理机制问题，以更好地为提供 治疗

PROJECT SUMMARY Chronic pain is common, costly, and debilitating. 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 for opioid dependence. Despite the alarming increases in prescription opiate misuse and opioid use disorder (OUD) nationally in the United States, there are few treatment options available that target both pain-related interference and OUD among patients with chronic pain. In military veterans, this issue is of particular importance as numerous reports indicate frequent use of opioids in the treatment of chronic pain, as well as increasing opioid-related problems. To date, there are no evidenced-based treatment options which aim to both reduce pain interference simultaneously addressing problematic opioid use. The overall aim of the present study will be to determine the efficacy of an integrated psychosocial treatment in veterans with chronic pain, who are taking buprenorphine for the treatment of OUD. To examine this aim, we will utilize a randomized design to assess the efficacy of two empirically supported interventions: Acceptance and Commitment Therapy for chronic pain and Mindfulness Based Relapse Prevention for substance use and misuse. Efficacy will be assessed by examining pain interference and substance use outcome after three months of active treatment, as well as at 6 and 12 month follow-ups. Secondary outcomes, including depression, pain-related fears, and opioid misuse risk, will also be assessed at these same follow-ups. The study will also examine the relation between within-treatment changes in treatment mechanisms, including pain acceptance, engagement in values based action, and opioid craving, and changes at post- treatment and follow-up. 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 OUD 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 provision of treatment.