Groeger Justina L, Perez Hector R, Moonaz Steffany, Bartels Matthew N, Rand Stephanie, Ghiroli Megan M, Zhang Chenshu, Bao Yuhua, Gabbay Vilma, Estremera Genesis V, Bryant Genevieve, Hidalgo Jennifer, Hribar Mary B, Rodgers Caryn R R, Savitzky Jamie, Stein Melissa R, Uebelacker Lisa A, Starrels Joanna L, Nahvi Shadi
Division of General Internal Medicine, Montefiore Health System, Bronx, NY, USA.
Division of General Internal Medicine, Albert Einstein College of Medicine, Bronx, NY, USA.
Subst Use Addctn J. 2025 Jan;46(1):175-183. doi: 10.1177/29767342241265929. Epub 2024 Aug 1.
There is a lack of integrated treatment for chronic pain and opioid use disorder (OUD). Yoga and physical therapy (PT) may improve pain and physical function of people living with (PLW) chronic low back pain (CLBP) and may also reduce opioid craving and use, but PLW with OUD face barriers to accessing these interventions. We hypothesize that compared to treatment as usual (TAU), providing yoga and PT onsite at opioid treatment programs (OTPs) will be effective at improving pain, opioid use, and quality of life among people with CLBP and OUD, and will be cost-effective.
In this hybrid type-1 effectiveness-implementation study, we will randomly assign 345 PLW CLBP and OUD from OTPs in the Bronx, NY, to 12 weeks of onsite yoga, onsite PT, or TAU. Primary outcomes are pain intensity, opioid use, and cost-effectiveness. Secondary outcomes include physical function and overall well-being.
This trial tests an innovative, patient-centered approach to combined management for pain and OUD in real-world settings. We rigorously examine the efficacy of yoga and PT onsite at OTPs as nonpharmacologic, cost-effective treatments among people with CLBP and OUD who face barriers to integrated care.
慢性疼痛和阿片类物质使用障碍（OUD）缺乏综合治疗方法。瑜伽和物理治疗（PT）可能会改善慢性下腰痛（CLBP）患者的疼痛和身体功能，也可能减少对阿片类物质的渴望和使用，但患有OUD的患者在获得这些干预措施方面面临障碍。我们假设，与常规治疗（TAU）相比，在阿片类物质治疗项目（OTP）现场提供瑜伽和PT将有效改善CLBP和OUD患者的疼痛、阿片类物质使用情况及生活质量，并且具有成本效益。
在这项1型混合有效性-实施性研究中，我们将把纽约布朗克斯区OTP的345名CLBP和OUD患者随机分为三组，分别接受为期12周的现场瑜伽、现场PT或TAU。主要结局指标为疼痛强度、阿片类物质使用情况和成本效益。次要结局指标包括身体功能和总体幸福感。
本试验在现实环境中测试一种创新的、以患者为中心的疼痛和OUD联合管理方法。我们严格检验在OTP现场进行瑜伽和PT作为非药物、具有成本效益的治疗方法对面临综合护理障碍的CLBP和OUD患者的疗效。
