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

项目总结 慢性疼痛很常见，代价高昂，而且让人虚弱。阿片类药物处方在慢性阻塞性肺疾病治疗中的应用 疼痛是经常发生的，因此带来治疗结果不佳的风险，而且更高。 临床上大量患者的发病率和死亡率，特别是那些符合 阿片类药物依赖的标准。尽管处方鸦片滥用和滥用的增加令人震惊 在美国，阿片类药物使用障碍(OUD)在全国范围内几乎没有治疗选择 可针对慢性疼痛患者的疼痛相关干预和OUD。 在退伍军人中，这一问题特别重要，因为许多报告表明， 在治疗慢性疼痛中使用阿片类药物，以及增加与阿片类药物有关的问题。至 到目前为止，还没有以证据为基础的治疗方案，既能减轻疼痛 同时解决阿片类药物使用问题的干扰。当前的总体目标 研究将确定退伍军人接受综合心理社会治疗的疗效 慢性疼痛，正在服用丁丙诺啡治疗OUD。为了检查这一目标，我们 将利用随机设计来评估两种有经验支持的干预措施的有效性： 接受和承诺疗法治疗基于慢性疼痛和正念的复发 预防药物使用和滥用。将通过检查疼痛来评估疗效 积极治疗3个月后和6个月后的干预和药物使用结果 并进行12个月的随访。次要结果，包括抑郁、与疼痛相关的恐惧和 阿片类药物滥用风险，也将在这些后续行动中进行评估。这项研究还将检查 包括疼痛在内的治疗机制的内部治疗变化之间的关系 接受，参与基于价值观的行动，阿片类药物渴望，以及在后 治疗和随访。这项研究的结果将直接指导慢性疼痛的治疗 并代表着在不断增长和未被研究的OUD问题上的重大进展 在慢性疼痛患者中。除了解决治疗是否是 在可行的情况下，它将进一步审查治疗机制的问题，以更好地向 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.