为慢性疼痛和阿片类药物使用者障碍患者开发一种新的治疗方法。
Developing a novel treatment for patients with chronic pain and Opioid User Disorder.
机构信息
Department of Psychology, University of Colorado Denver, Denver, USA.
Department of Psychiatry, University of Massachusetts Medical School, Worcester, USA.
出版信息
Subst Abuse Treat Prev Policy. 2022 May 7;17(1):35. doi: 10.1186/s13011-022-00464-4.
BACKGROUND
It is critical to develop empirically based, community-treatment friendly, psychotherapy interventions to improve treatment for patients with comorbid chronic pain and Opioid Use Disorder. Understanding factors that increase patient adherence and attendance is important, along with strategies targeted to address those issues.
METHODS
Based on initial psychophysiology research on adults with OUD and chronic pain, we created an integrated cognitive-behavioral, 12-week outpatient group therapy called STOP (Self-regulation Therapy for Opioid addiction and Pain). In this study, we pilot tested STOP in a Stage 1a feasibility and acceptability study to identify unique treatment needs and factors that increased session attendance, adherence to treatment, and improved outcomes. Fourteen individuals on medication for OUD with co-occurring chronic pain participated.
RESULTS
STOP had high attendance rates (80%; and active patient engagement). Urine toxicology showed no illicit drug use after week 8. Data analysis from pre-intervention to a 3-month follow-up showed significant functional improvement (F(1,12) = 45.82;p < 0.001) and decreased pain severity levels (F(1,12) = 37.62;p < 0.01). Participants reported appreciation of the unique tools to counteract physiological activation during a pain flare or craving. Participants also reported benefit from in-session visual aids, applicable pain psychology information, take-home worksheets, tools for relaxation practice, learning to apply the therapy tools.
DISCUSSION
STOP is a 90-min 12-week rolling-entry group therapy based on previous research identifying psychophysiological needs of pain and OUD patients that can be seamlessly incorporated into community addiction treatment clinics.
CONCLUSION
Preliminary results of STOP are promising with high patient engagement and adherence and significant reductions in drug use and pain.
TRIAL REGISTRATION
ClinicalTrials.Gov NCT03363243 , Registered Dec 6, 2017.
背景
开发基于经验的、适合社区治疗的心理治疗干预措施对于改善慢性疼痛合并阿片类药物使用障碍患者的治疗至关重要。了解增加患者依从性和就诊率的因素，以及针对这些问题的策略是很重要的。
方法
基于对患有阿片类药物使用障碍和慢性疼痛的成年人的初始心理生理学研究，我们创建了一种综合认知行为、为期 12 周的门诊团体治疗方法，称为 STOP（针对阿片类药物成瘾和疼痛的自我调节治疗）。在这项研究中，我们在一项 1a 期可行性和可接受性研究中对 STOP 进行了试点测试，以确定独特的治疗需求以及增加就诊率、治疗依从性和改善结果的因素。14 名接受阿片类药物治疗的阿片类药物使用障碍合并慢性疼痛患者参与了研究。
结果
STOP 的出勤率很高（80%，患者积极参与）。尿液毒理学检测显示，第 8 周后没有非法药物使用。从干预前到 3 个月随访的数据分析显示，功能显著改善（F（1,12）=45.82;p<0.001），疼痛严重程度降低（F（1,12）=37.62;p<0.01）。参与者报告说，他们很欣赏在疼痛发作或渴望时用来对抗生理激活的独特工具。参与者还报告说，他们从课堂上的视觉辅助工具、适用的疼痛心理学信息、带回家的工作表、放松练习工具、学习应用治疗工具中受益。
讨论
STOP 是一种 90 分钟的 12 周滚动式团体治疗方法，基于之前的研究确定了疼痛和阿片类药物使用障碍患者的心理生理学需求，这些需求可以无缝地纳入社区成瘾治疗诊所。
结论
STOP 的初步结果很有希望，患者的参与度和依从性很高，药物使用和疼痛显著减少。
试验注册
ClinicalTrials.Gov NCT03363243，注册于 2017 年 12 月 6 日。
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