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

• 批准号: 10561600
• 负责人: Michael D Stein
• 金额: $ 66.71万
• 依托单位: BOSTON UNIVERSITY MEDICAL CAMPUS
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-02-15 至 2025-01-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10561600
• 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; Pharmacotherapy; Phase; Physical activity; Population; Primary Care; Protocols documentation; Provider; Psychologist; Psychotherapy; Public Health; Randomized, Controlled Trials; Research; Research Design; Severities; Social Workers; Specialist; Testing; Treatment outcome; Work; acceptability and feasibility; addiction; behavioral health; buprenorphine treatment; 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; pharmacologic; prescription opioid; primary care provider; primary care setting; primary outcome; programs; psychosocial; randomized, clinical trials; recruit; relative cost; secondary outcome; substance use; substance use treatment; symptom treatment; targeted treatment; treatment planning

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 近 50 万美国人因阿片类药物使用障碍 (OUD) 服用丁丙诺啡，其中超过 40%。 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 但目前还没有有效的非药物疗法来改善疼痛结果。 疼痛治疗因以下事实而变得复杂：在阿片类药物依赖患者中，疼痛常常与 我们开发了一种协作初级保健方法，名为 TOPPS（治疗阿片类药物患者） 疼痛和悲伤），其中行为健康专家和初级保健提供者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问题。 整合并建立在针对慢性疼痛和抑郁的行为疗法之上，旨在减少 在我们的试点工作中，我们证明了 TOPPS。 符合可行性和初步功效的标准，并且基于我们的 R34 研究结果，我们现在提出一个 TOPPS 与健康教育接触对照条件进行比较的随机对照试验，受试者为 250 人 从两个基于初级保健的丁丙诺啡项目招募的 OUD 患者我们将提供这两种药物。 为期三个月的干预措施并跟踪参与者总共 12 个月，以观察短期 TOPPS 的短期和长期影响。 ain相关的 干扰身体和心理功能 （“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，我们的研究目标是： 结果是将理论驱动的、经过实证检验的治疗纳入丁丙诺啡护理中 我们相信 TOPPS 将改善疼痛、抑郁和抑郁症状。 物质使用结果，并可以利用丁丙诺啡计划中可用的提供者，扩大 这种新颖干预措施的传播性，并提高其在国内和国际上的公共卫生影响。