Treating Chronic Pain in Buprenorphine Patients in Primary Care Settings

在初级保健机构中治疗丁丙诺啡患者的慢性疼痛

基本信息

批准号：
10343721
负责人：
Michael D Stein
金额：
$ 74.96万
依托单位：
BOSTON UNIVERSITY MEDICAL CAMPUS
依托单位国家：
美国
项目类别：
财政年份：
2019
资助国家：
美国
起止时间：
2019-02-15 至 2024-01-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/10343721
关键词：
Address Affect American Attention Behavior Therapy Behavioral Buprenorphine Caring Clinical Cognitive Therapy Collaborations Data Depressed mood Fright Goals Health Care Costs Health education Individual International Intervention Joints Life Measures Medical Mental Depression Methadone Nonpharmacologic Therapy Nurses Opiate Addiction Opioid Outcome Pain Pain interference Pain management Participant Patient-Focused Outcomes Patients Persons Pharmacology Pharmacotherapy Phase Physical activity Population Primary Health Care Protocols documentation Provider Psychologist Psychotherapy Public Health Randomized Clinical Trials Randomized Controlled Trials Research Research Design Severities Social Workers Specialist Testing Treatment outcome Work acceptability and feasibility addiction base behavioral health buprenorphine treatment care providers chronic depression chronic pain chronic pain management chronic pain patient comorbidity depressive symptoms disability improved meetings novel opioid use disorder pain outcome pain reduction pain relief pain symptom patients who use opioids prescription opioid primary care setting primary outcome programs psychosocial recruit relative cost secondary outcome substance use substance use treatment symptom treatment targeted treatment treatment planning

项目摘要

ABSTRACT Nearly half a million Americans receive buprenorphine for opioid use disorder (OUD). More than 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. We developed a collaborative primary care approach, entitled TOPPS (Treating Opioid Patients’ Pain and Sadness), in which behavioral health specialists and primary care providers share a unified plan for addressing pain and depression in patients receiving buprenorphine. The newly developed intervention integrates and builds upon behavior therapy for chronic pain and depression with the aim of reducing behavioral avoidance and increasing behavioral activation. In our pilot work, we demonstrated that TOPPS meets standards of feasibility and preliminary efficacy and, building on our R34 findings, we now propose a randomized controlled trial of TOPPS compared to a health education contact-control condition among 250 persons with OUD recruited from two primary care-based buprenorphine programs. We will provide both interventions over three months and follow participants for a total of 12 months in order to observe both short- term and longer-term effects of TOPPS. P ain-related interference with physical and psychosocial functioning (“pain interference”), pain severity and depression will be the primary outcome variables assessed, and buprenorphine treatment retention will be the secondary outcome variable. Our goal is for this research to result in the incorporation into buprenorphine care of theoretically-driven, empirically-tested therapy for patients with pain and depressive symptoms. We believe that TOPPS will lead to improved pain, depression, and substance use outcomes, and can utilize providers available within buprenorphine programs, broadening the disseminability of this novel intervention and heightening its public health impact nationally and internationally.

抽象的将近一百万的美国人因阿片类药物使用障碍（OUD）接受丁丙诺啡。其中40％以上寻求丁丙诺啡治疗的疼痛会干扰日常活动并影响药物治疗结果，但没有有效的非药理疗法来改善疼痛结果。发展小说在阿片类药物依赖性患者中，疼痛经常与沮丧。我们开发了一种合作的初级保健方法，标题为TOPPS（治疗阿片类药物患者痛苦和悲伤），在哪个行为健康专家和初级保健提供者中共享一个统一的计划解决接受丁丙诺啡的患者的疼痛和抑郁。新开发的干预措施为了减少慢性疼痛和抑郁症的行为疗法并基于行为疗法避免行为并增加行为激活。在我们的飞行员工作中，我们证明了Topps 符合可行性和初步效率的标准，并以R34调查结果为基础，我们现在建议与健康教育接触控制条件相比，TOPP的随机对照试验250 OUD的人从两个基于初级保健的丁丙诺啡计划中招募。我们将提供两者三个月内的干预措施，并关注参与者总共12个月，以观察两个短暂的 TOPPS的术语和长期影响。 p 与AIN相关干扰身体和社会心理功能（“疼痛干扰”），疼痛严重程度和抑郁将是评估的主要结果变量，并且丁丙诺啡治疗保留将是次要结果变量。我们的目标是这项研究为患者的理论驱动，经验疗法的丁丙诺啡护理导致保险疼痛和抑郁症状。我们认为，TOPPS会导致疼痛，抑郁和物质使用结果，可以利用丁丙诺啡计划中可用的提供商，从而扩大这种新颖的干预措施的分散性并在国内和国际上加剧了公共卫生的影响。