Adapting Web-based CBT to improve adherence and outcome for individuals with opioid use disorder and chronic pain treated with opioid agonists

采用基于网络的 CBT 来提高阿片类药物使用障碍和阿片类药物激动剂治疗慢性疼痛患者的依从性和结果

• 批准号: 10569775
• 负责人: Alicia Heapy
• 金额: $ 97.02万
• 依托单位: YALE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-06-01 至 2025-02-28
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10569775
• 关键词: Abstinence; Acute; Address; Adherence; Affect; Agonist; Back; Behavior Therapy; Behavioral; Behavioral Research; Buprenorphine; Cognitive; Cognitive Therapy; Complex; Coping Skills; Data; Development; Drug usage; E-learning; Education; Educational process of instructing; Enrollment; Exercise; Exploratory/Developmental Grants Phase II; Feedback; Frequencies; Goals; Grain; Helping to End Addiction Long-term; Individual; Intervention; Measures; Medical; Mental disorders; Methadone; Monitor; Nature; Online Systems; Opioid; Opioid agonist; Outcome; Pain; Pain Threshold; Pain intensity; Pain interference; Patients; Phase; Physical activity; Population; Provider; Public Health; Randomized Clinical Trials; Sampling; Self Efficacy; Self Management; Sleep Disorders; Standardization; Substance Use Disorder; Technology; Testing; TimeLine; Toxicology; Urine; Variant; Videotape; acceptability and feasibility; base; chronic pain; chronic pain management; comorbidity; cost; craving; efficacy evaluation; experience; feasibility testing; follow-up; health care service; improved; medication-assisted treatment; opioid agonist therapy; opioid epidemic; opioid use disorder; pain outcome; pilot test; primary endpoint; programs; response; satisfaction; secondary outcome; skills; sleep quality; social interventions; standard care; treatment as usual; web-based intervention

Chronic pain is common among individuals treated with opioid agonist therapies (OAT; buprenorphine or methadone) and is associated with poorer opioid use disorder (OUD) outcomes, including higher attrition and higher levels of drug use. Treatment of chronic pain in individuals who are maintained on OAT is complex, as presence of chronic pain is associated with greater frequency of psychiatric disorders as well as sleep problems and other comorbidities that can contribute to poorer outcomes. Given the large number of individuals with chronic pain seeking OAT, standardized, lower-cost, and easily disseminable approaches to treat individuals in OAT who have chronic pain are needed and, if demonstrated to be effective in this population, would have high public health significance. In response to RFA-AT-19-006, we plan to develop and pilot test an integrated, web-based cognitive behavioral approach (R61 phase), and then conduct a randomized clinical trial evaluating its efficacy relative to standard care in a large and diverse sample of individuals with chronic pain treated with buprenorphine or methadone (R33 phase). The new program will retain key components of Dr. Carroll’s computer-based training for cognitive-behavioral therapy (CBT4CBT), including its emphasis on teaching cognitive and behavioral coping skills in an engaging way and focus on the 5 A’s of MAT (Adherence, Attendance, Abstinence, Alternate Activities and Accessing support); it will add components from Dr. Heapy’s COPES (Cooperative Pain Education and Self-Management) intervention (self-management of chronic pain, with IVR monitoring of pain intensity and interference, physical activity, and skills practice) and modify existing CBT4CBT modules to address the complex interplay between pain and drug use in this population, emphasizing the development of generalizable skills. In the R33 phase, we will conduct a randomized clinical trial evaluating CBT4CBT-COPES in a diverse sample 160 of individuals enrolled in agonist treatment (methadone or buprenorphine) who have chronic pain, in a 3-month randomized clinical trial with a 6-month follow-up, comparing it to standard treatment alone. The primary retention outcome will be adherence with agonist treatment; the primary pain outcome will be the PROMIS 6-item Pain Interference Short Form.

慢性疼痛在接受阿片类药物激动剂疗法治疗的个体中很常见（燕麦； 丁丙诺啡或MEADADONE），与较差的阿片类药物使用障碍（OUD）有关 结果，包括较高的属性和较高水平的药物使用。治疗慢性疼痛 维持在燕麦上的个体很复杂，因为慢性疼痛的存在与 具有更高的精神疾病以及睡眠问题和其他 可以导致较差结果的合并症。鉴于大量个人 随着慢性疼痛寻求燕麦，标准化，较低的成本和易于分散的方法 需要在燕麦中治疗慢性疼痛的人，如果被证明是 在这一人群中有效，将具有很高的公共健康意义。 为了响应RFA-AT-19-006，我们计划开发和试点测试 认知行为方法（R61期），然后进行随机临床试验 评估其相对于标准护理的有效性，在大量和多样化的个体样本中 用丁丙诺啡或替代酮治疗的慢性疼痛（R33期）。新程序将 保留Carroll博士基于计算机的认知行为疗法的关键组成部分 （CBT4CBT），包括强调在一个人中教授认知和行为应对技巧 互动的方式和专注于垫子的5 a（坚持，出勤，禁欲，替代 活动和访问支持）；它将添加Heapy博士的应对的组件 （合作疼痛教育和自我管理）干预（慢性自我管理 疼痛，通过IVR监测疼痛强度和干扰，体育锻炼和技能练习） 并修改现有的CBT4CBT模块，以解决疼痛和 该人群中的吸毒，强调了可推广技能的发展。在R33中 阶段，我们将进行一项评估潜水员中CBT4CBT-copes的随机临床试验 接受激动剂治疗的人（美沙酮或丁丙诺啡）的160个样本 慢性疼痛，在3个月的随机临床试验中进行了6个月的随访，将其比较 仅标准治疗。主要的保留结果将是遵守激动剂的 治疗;主要的疼痛结果将是Promis 6-项目疼痛干扰短形式。