Using Human Centered Design to Tailor a Web-based Behavioral Treatment for Chronic Pain and Opioid Use Disorder

PROJECT SUMMARY/ABSTRACT Opioid misuse and chronic pain are two converging national public health crises. In 2023 alone, nearly 100,000 Americans died due to drug overdoses, and 70% were attributable to opioids. Nearly half of people with an opioid use disorder (OUD) have chronic pain, which increases risk of illicit opioid use, suboptimal OUD treatment retention, and overdose. Behavioral pain interventions are safe and effective first-line interventions for chronic pain and focus on building self-management strategies to cope with pain and its impacts on functioning; however, few have been developed for, or tested and implemented among people with OUD. Even fewer options exist that are widely accessible and scalable. One promising behavioral approach involves combining two evidenced-based treatments: Acceptance and Commitment Therapy (ACT) for chronic pain and mindfulness-based relapse prevention (MBRP) for substance use disorders (ACT+MBRP). A pilot study found ACT+MBRP to be feasible and acceptable and preliminarily reduce pain and opioid use outcomes. However, existing iterations of this intervention have significant limitations, including lack of tailoring to people with chronic pain and OUD and high treatment burden (18 hours), thus potentially limiting its impact and scalability. The current proposal, led by Principal Investigator Dr. Edwards in collaboration with her mentorship team, aims to address these limitations by developing a guided, web-based ACT+MBRP intervention in collaboration with patients to increase its impact and scalability. Specifically, Aim 1 proposes to develop the guided web-based ACT+MBRP intervention in collaboration with patients who have lived experience with chronic pain and OUD (N=12-15) using the Human-Centered, Evidence-Driven Adaptive Design (AHEAD) framework. Aim 2A proposes to assess the feasibility, acceptability, and preliminary impact of the intervention in a pilot randomized control trial (N=40) among people with chronic pain and OUD who are receiving a medication for OUD (e.g., buprenorphine, methadone). Lastly, Aim 2B proposes to assess barriers and facilitators among people who received the intervention (n=20), which will be used to inform future iterations and implementation strategies. Throughout the award period, I will build upon my prior research and clinical training in chronic pain and addiction to develop new skills and knowledge in the development of behavioral interventions, human centered design, digital delivery methods, conduct of clinical trials, implementation science, and R-series grant writing. My proposed career development training plan integrates coursework, formal training, practical experience, applied training, and mentorship from experts in the field of chronic pain and addiction (Drs. Merlin, Liebschutz, Jonassaint, Hamm, Witkiewitz). This mentored patient orientated career development award (K23) will help me achieve my long-term career goal to increase access to effective, patient-centered behavioral pain treatments and improve pain and addiction outcomes.