Co-Morbid Opioid Addiction and Chronic Pain ABSTRACT The primary goal of this K23 - Mentored Patient-Oriented Research Career Development Award is to provide Dr. Amy Wachholtz, a clinical health psychologist, with the advanced research training, protected time for research, and mentored experiences necessary for her to become an independent researcher in developing and evaluating innovative treatments for opioid addiction and co-morbid pain that are integrative (pharmacotherapy and psychosocial treatment) and novel (CBT and Self-Regulation Techniques). The candidate proposes a program of research and training to meet this career goal including: 1) developing knowledge about the psychological and physiological interactions between opioid addiction and pain , 2) increasing her knowledge about psychological and pharmacological treatment approaches to addiction, 3) building skills in psycho-social treatment development, 4) enhancing her understanding of advanced statistical techniques, and 5) building expertise in grant writing and grant administration. Dr. Wachholtz will be guided by her primary mentor, Gerardo Gonzalez, MD, and two co-mentors, Douglas Ziedonis, MD, MPH, and Martin Cheatle, PhD. Dr. Wachholtz will conduct two distinct studies in the area of co-morbid pain and opioid addiction. The first study (Pain Reactivity Study) is a laboratory study of 120 participants;90 with opioid addiction and chronic pain to identify the unique physiological, psychological, and behavioral responses to induced pain among those on methadone opioid maintenance treatment for opioid addiction (30 participants);on buprenorphine opioid maintenance treatment (30 participants), with an opioid addiction history but prolonged abstinence (6+ months) from opioids (30 participants), and 30 opioid naive participants. Based on findings from the first study, the second study (Intervention Study) will develop and pilot test 30 subjects in an integrated CBT + Self-Regulation psycho-social treatment for co-morbid opioid addiction and pain to decrease substance use, reduce pain, and decrease physiological reactivity to pain and distress. Results will inform a future R01 application to test an integrated treatment for co-morbid pain and opioid addiction. Successful completion of this K23 award will advance Dr. Wachholtz into a career as an independent researcher with the expertise to conduct clinical research trials to improve treatment for co-morbid opioid addiction and pain.
Opioid addiction and pain are common co-morbidities, and pain is strongly related to opioid addiction relapse, yet there is limited knowledge about the unique pain reactions among those with opioid addiction and few treatments. These studies will add to the current knowledge by 1) identifying unique bio-psycho-social responses to pain in those on opioid maintenance;and 2) using this information to develop a novel CBT+ self- regulation intervention to provide a much needed empirically validated treatment option for individuals with co- morbid opioid addiction and pain.
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