Pilot Study of Combined Treatment for Veterans With Chronic Pain & Opiate Misuse
Condition: Chronic Pain; Problematic Opioid Use
MeSH terms: Chronic Pain
Study type: Interventional

Summary: 
      Chronic pain and misuse of opioids is a major public health problem, particularly in military
      veterans. The major goal of this project is to test the efficacy of an innovative behavioral
      treatment for chronic pain patients who are misusing prescription opiates. This project
      supports the strategic goals of National Center for Complementary and Integrative Health
      (NCCIH) and National Institute on Drug Abuse by examining a difficult and understudied
      problem with the ultimate goal of impacting scientific knowledge and human health.
    

Detailed description: 
      Opioid prescription in the treatment of chronic pain is frequent and carries a consequent
      risk of poor treatment outcome, as well as higher morbidity and mortality in a clinically
      significant number of patients, particularly those who meet criteria for opioid dependence.
      Despite the alarming increases (140% increase from 1992 to 2003) in prescription opiate
      misuse, abuse, and dependence nationally in the United States, there are few treatment
      options available that target both pain-related interference and opioid dependence among
      patients with chronic pain. In military veterans, this issue is of particular importance as
      numerous reports indicate increasing use of opioids in the treatment of chronic pain, as well
      as increasing opioid-related problems, specifically in those who served in the Iraq and
      Afghanistan theatres [Operation Enduring Freedom (OEF), Operation Iraqi Freedom (OIF), and
      Operation New Dawn (OND)]. To date, there are no evidenced-based treatment options which aim
      to both maximize effective functioning in Veterans with chronic pain while simultaneously
      addressing problematic opioid use. The overall aim of the present study will be to determine
      the feasibility of an integrated psychosocial treatment in veterans with chronic pain, who
      also have evidence of opioid-related misuse. To examine this aim, the investigators will
      utilize a randomized design to assess the feasibility of integrating two empirically
      supported interventions: Acceptance and Commitment Therapy for chronic pain and Mindfulness
      Based Relapse Prevention for substance use and misuse. Feasibility will be assessed by
      examining rates of recruitment and retention of participants through a six month follow-up.
      In addition, the investigators will evaluate progress within-treatment on specific therapy
      targets to aid in the identification of potential treatment mechanisms. The results of this
      study will directly inform treatment of chronic pain patients and represents a significant
      advance in the growing and understudied problem of opiate misuse among chronic pain patients.
      In addition to addressing the question of whether the treatment is feasible, it will further
      examine issues of treatment mechanisms to better inform the design of a randomized and
      controlled trial assessing treatment efficacy.
    

Intervention name(s): Acceptance and Commitment Therapy + Mindfulness-Based Relapse Prevention + Treatment as Usual (TAU)
Intervention type(s): Behavioral
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Double (Participant, Outcomes Assessor)
Primary purpose: Treatment