Psychosocial pain management to improve opioid use disorder treatment outcomes

心理社会疼痛管理可改善阿片类药物使用障碍的治疗结果

• 批准号: 10020320
• 负责人: MARK A. ILGEN
• 金额: $ 75.83万
• 依托单位: UNIVERSITY OF MICHIGAN AT ANN ARBOR
• 依托单位国家: 美国
• 财政年份: 2018
• 资助国家: 美国
• 起止时间: 2018-09-20 至 2022-09-19
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10020320
• 关键词: Abstinence; Address; Adherence; Adult; Aftercare; Alcohol or Other Drugs use; Automobile Driving; Award; Behavioral; Buprenorphine; Caring; Clinic; Cognitive; Cognitive Therapy; Collaborations; Contracts; County; Dropout; Early treatment; Elements; Expert Opinion; Faculty; Foundations; Frequencies; Funding; Grant; Health; Health Services Accessibility; Human; Individual; Intervention; Intervention Trial; Interview; Knowledge; Lead; Link; Michigan; Morbidity - disease rate; Opioid; Outcome; Pain; Pain management; Participant; Patient-Focused Outcomes; Patients; Pharmaceutical Preparations; Poisoning; Population; Provider; Randomized; Randomized Controlled Trials; Relapse; Research; Services; Substance Use Disorder; Suicide; Telephone; Testing; Time; TimeLine; Treatment Efficacy; Treatment outcome; United States National Institutes of Health; United States Substance Abuse and Mental Health Services Administration; Universities; Work; addiction; adverse outcome; base; chronic pain; chronic pain patient; comorbidity; effective intervention; evidence base; experience; follow-up; high risk; high risk population; improved; improved outcome; innovation; medication-assisted treatment; mortality; novel; opioid epidemic; opioid overuse; opioid use; opioid use disorder; patient population; portability; primary outcome; programs; psychosocial; recruit; response; secondary outcome; telehealth; treatment as usual; treatment program

ABSTRACT Developing new strategies to address pain in patients with opioid use disorder (OUD) is critical to improving outcomes for the large population of patients with comorbid chronic pain and OUD. With the national opioid epidemic, which has been propelled by overuse of opioids for pain, efforts are underway to increase access to medication assisted treatment (MAT), especially with the medication buprenorphine. However, many individuals who receive MAT leave treatment early and continue to struggle with opioid use, often within the context of poorly-managed comorbid chronic pain. New strategies to help patients cope with and adapt to chronic pain are urgently needed. Psychosocial interventions for pain have been effective in patients with chronic pain and substance use disorders, but these interventions have not been examined in the OUD population receiving MAT. Our team received a SAMHSA State Targeted Response to Opioid Crisis grant to help providers increase delivery of MAT in Southeast Michigan. Providing alternative pain treatment options has the potential to be an important component delivering effective MAT. The purpose of this study is to refine and adapt a psychosocial pain management intervention (PPMI) to be delivered by telephone for patients with OUD receiving MAT and then to conduct a randomized controlled trial of the intervention in patients receiving MAT to improve OUD adherence and pain- and substance-related outcomes. The intervention uses elements of cognitive behavioral pain management interventions adapted specifically for patients with OUD receiving MAT. This new intervention will be compared to an enhanced usual care condition (EUC). The study will recruit 100 patients with OUD and comorbid pain receiving MAT in clinics in southeast Michigan. The specific aims are: R21 Specific Aim 1: Using qualitative patient interviews, adapt a telephone-based PPMI and enhanced usual care (EUC) condition to address the needs of individuals with pain and OUD receiving MAT. R21 Specific Aim 2: Iteratively refine the PPMI and EUC informed (1) by beta-testing with patients with OUD and chronic pain and (2) by expert opinion. R33 Specific Aim 1: Conduct a pilot RCT comparing a telephone-based PPMI approach (n=50) to EUC (n=50) to assess the impact of randomization to PPMI on retention to MAT (primary outcome). R33 Specific Aim 2: Determine the impact of the PPMI on pain level, pain-related functioning, and frequency of opioid use (secondary outcomes). Knowledge generated in this study will have important implications for improving outcomes for patients with OUD and chronic pain through increased understanding of effective patient-focused psychosocial strategies to help patients better manage pain. Ultimately, this line of research has the potential to lead to reductions in morbidity and mortality among the large number of patients suffering from OUD and chronic pain.

抽象的 制定解决阿片类药物使用障碍患者疼痛（OUD）疼痛的新策略至关重要 改善合并症慢性疼痛和OUD患者的大量患者的结果。与国民 阿片类流行病已被阿片类药物过度使用疼痛所推动，正在努力增加 获得药物辅助治疗（MAT），尤其是用药物丁丙诺啡。但是，很多 接受垫子休假治疗的个人，并继续在阿片类药物使用方面挣扎 管理不良的合并症慢性疼痛的背景。帮助患者应对并适应的新策略 迫切需要慢性疼痛。疼痛的社会心理干预对患者有效 慢性疼痛和药物使用障碍，但在OUD中尚未检查这些干预措施 人口接收垫子。我们的团队获得了SAMHSA州的目标，以对阿片类药物危机赠款的反应 帮助提供商增加密歇根州东南部的MAT的交付。提供替代性疼痛治疗选择 有可能成为提供有效垫的重要组成部分。 这项研究的目的是完善和适应社会心理疼痛管理干预（PPMI） 通过电话为OUD接收垫的患者交付，然后进行随机对照试验 干预接受MAT以提高OUD依从性以及与疼痛和物质有关的患者的干预措施 结果。该干预使用适应的认知行为疼痛管理干预措施的要素 专为OUD接收垫的患者。这种新的干预将与增强的平常相提并论 护理状况（EUC）。该研究将在诊所招募100名患有OUD和合并疼痛的患者 在密歇根州东南部。具体目的是： R21特定目标1：使用定性患者访谈，适应基于电话的PPMI并增强 通常的护理（EUC）条件，以满足疼痛和OUD接收垫的人的需求。 R21特定目标2：迭代地完善PPMI和EUC，通过与患者进行β测试的情况（1） OUD和慢性疼痛以及（2）专家意见。 R33特定目标1：进行试验RCT，将基于电话的PPMI方法（n = 50）与EUC进行比较 （n = 50）评估随机分配到PPMI对保留对MAT的影响（主要结果）。 R33特定目标2：确定PPMI对疼痛水平，与疼痛相关的功能和 阿片类药物使用的频率（次要结果）。 这项研究中产生的知识将对改善患者的预后有重要影响 OUD和慢性疼痛通过对有效以患者为中心的心理社会策略的了解来增加 帮助患者更好地控制疼痛。最终，这一研究有可能导致减少 大量患有OUD和慢性疼痛的患者的发病率和死亡率。