Rationale and Design of a Multisite Randomized Clinical Trial Examining an Integrated Behavioral Treatment for Veterans with Co-occurring Chronic Pain and Opioid Use Disorder: The Pain and Opioids Integrated Treatment in Veterans (POSITIVE) Trial

Overview

Journal Contemp Clin Trials

Publisher Elsevier

Date 2023 Jan 24

PMID 36693589

Authors

Kevin E Vowles

Katie Witkiewitz

Erik Clarke

Zachary Schmidt

Brian Borsari

Karlyn E Edwards

J Richard Korecki

David I Moniz-Lewis

Juliana A Bondzie

Chloe Mullins

Claire I Thoreson

Joannalyn Delacruz

Consuelo H Wilkins

Sarah Nelson

Jennifer Delventura

Ryan Henderson

Andrea Katz

William Hua

Erin Watson

Catherine Baxley

Bernard R Canlas

Tiffany Pendleton

Ellen Herbst

Steven Batki

Affiliations

Soon will be listed here.

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.

Citing Articles

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