Robinson-Papp Jessica, Aberg Judith, Benn Emma K T, Bryan Angela, Cedillo Gabriela, Chikamoto Yosuke, George Mary Catherine, Horn Brady, Kamler Alexandra, Navis Allison, Nmashie Alexandra, Scherer Maya, Starkweather Angela, Vickrey Barbara, Weiss Linda, Yang Qiuchen, Fisher Jeffrey
Icahn School of Medicine at Mount Sinai, Department of Neurology, USA.
Icahn School of Medicine at Mount Sinai, Department of Medicine, Division of Infectious Diseases, USA.
Contemp Clin Trials Commun. 2019 Oct 12;16:100468. doi: 10.1016/j.conctc.2019.100468. eCollection 2019 Dec.
Many people with HIV (PWH) experience chronic pain that limits daily function and quality of life. PWH with chronic pain have commonly been prescribed opioids, sometimes for many years, and it is unclear if and how the management of these legacy patients should change in light of the current US opioid epidemic. Guidelines, such as the Centers for Disease Control and Prevention Guideline for Prescribing Opioids for Chronic Pain (CDCG), provide recommendations for the management of such patients but have yet to be translated into easily implementable interventions; there is also a lack of strong evidence that adhering to these recommendations improves patient outcomes such as amount of opioid use and pain levels. Herein we describe the development and preliminary testing of a theory-based intervention, called TOWER (ard Saf Opioid Prescribing), designed to support HIV primary care providers in CDCG-adherent opioid prescribing practices with PWH who are already prescribed opioids for chronic pain. TOWER incorporates the content of the CDCG into the theoretical and operational framework of the Information Motivation and Behavioral Skills (IMB) model of health-related behavior. The development process included elicitation research and incorporation of feedback from providers and PWH; testing is being conducted via an adaptive feasibility clinical trial. The results of this process will form the basis of a large, well-powered clinical trial to test the effectiveness of TOWER in promoting CDCG-adherent opioid prescribing practices and improving outcomes for PWH with chronic pain.
许多感染艾滋病毒的人（PWH）经历着慢性疼痛，这种疼痛限制了他们的日常功能和生活质量。患有慢性疼痛的PWH通常会被开阿片类药物，有时长达数年，目前尚不清楚鉴于美国当前的阿片类药物流行情况，这些遗留患者的治疗是否以及应如何改变。诸如疾病控制与预防中心《慢性疼痛阿片类药物处方指南》（CDCG）等指南为这类患者的治疗提供了建议，但尚未转化为易于实施的干预措施；也缺乏有力证据表明遵循这些建议能改善患者的治疗结果，如阿片类药物使用量和疼痛程度。在此，我们描述了一种基于理论的干预措施——TOWER（阿片类药物安全处方）的开发和初步测试，该措施旨在支持艾滋病毒初级保健提供者对已因慢性疼痛而服用阿片类药物的PWH进行符合CDCG的阿片类药物处方实践。TOWER将CDCG的内容纳入了健康相关行为的信息动机与行为技能（IMB）模型的理论和操作框架。开发过程包括启发式研究以及纳入提供者和PWH的反馈；测试正在通过一项适应性可行性临床试验进行。这一过程的结果将为一项大型、有充分效力的临床试验奠定基础，以测试TOWER在促进符合CDCG的阿片类药物处方实践以及改善患有慢性疼痛的PWH的治疗结果方面的有效性。
