ABSTRACT
BACKGROUND: Chronic pain and opioid use disorder (OUD) individually represent a risk to health and well-being. Concerningly, there is evidence that they are frequently co-morbid. While few treatments exist that simultaneously target both conditions, preliminary work has supported the feasibility of an integrated behavioral treatment targeting pain interference and opioid misuse. This treatment combined Acceptance and Commitment Therapy (ACT) and Mindfulness-Based Relapse Prevention (ACT+MBRP). This paper describes the protocol for the adequately powered efficacy study of this integrated treatment. METHODS: A multisite randomized controlled trial will examine the efficacy of ACT+MBRP in comparison to a parallel education control condition, focusing on opioid safety and pain education. Participants include veterans (n = 160; 21-75 years old) recruited from three Veterans Administration (VA) Healthcare Systems with chronic pain who are on a stable dose of buprenorphine. Both conditions include twelve weekly 90 min group sessions delivered via telehealth. Primary outcomes include pain interference (Patient Reported Outcome Measurement Information System - Pain Interference) and hazardous opioid use (Current Opioid Misuse Measure), which will be examined at the end of the active treatment phase and through 12 months post-intervention. Secondary analyses will evaluate outcomes including pain intensity, depression, pain-related fear, and substance use, as well as treatment mechanisms. CONCLUSION: This study will determine the efficacy of an integrated behavioral treatment program for pain interference and hazardous opioid use among veterans with chronic pain and OUD who are prescribed buprenorphine, addressing a critical need for more integrated treatments for chronic pain and OUD. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT04648228.
Subject(s)
Acceptance and Commitment Therapy , Buprenorphine , Chronic Pain , Opioid-Related Disorders , Veterans , Humans , Young Adult , Adult , Middle Aged , Aged , Analgesics, Opioid/therapeutic use , Chronic Pain/drug therapy , Opioid-Related Disorders/drug therapy , Buprenorphine/therapeutic useABSTRACT
A pain management program focused on improving self-management, function, and overall quality of life for veterans with chronic pain.
Subject(s)
Electric Stimulation/methods , Low Back Pain/therapy , Pain, Postoperative/therapy , Spinal Cord/physiology , Female , Humans , Low Back Pain/complications , Low Back Pain/etiology , Middle Aged , Orthopedic Procedures/adverse effects , Pain, Postoperative/complications , Pain, Postoperative/etiology , Scoliosis/surgeryABSTRACT
This article discusses the current updates in the post-operative pain management with regards to the pathophysiology of pain, adverse physiologic sequelae of pain, pharmacological considerations, and the use of oral, parenteral, peripheral nerve blocks and neuraxial analgesics in conjunction with the mutimodal approach in controlling post- surgical pain for better patient outcome.
