Treating Chronic Pain in Buprenorphine Patients in Primary Care Settings (TOPPS)
Opioid-Related Disorders
About this trial
This is an interventional treatment trial for Opioid-Related Disorders focused on measuring Depression, Pain, Cognitive behavioral therapy (CBT), Buprenorphine, Behavioral health specialist (BHS), Primary care provider (PCP)
Eligibility Criteria
Inclusion Criteria:
- Between 18 and 65 years of age
- Have chronic pain, defined as pain duration for at least three months with a mean score of 4 or higher on the BPI Pain Interference Scale
- Pain severity of 4 or higher on a numerical rating scale (0-10) indicating "worst pain in the last week"
- If using an antidepressant, the dose must be stable for the previous 2 months
- Has received buprenorphine from the current primary care provider for at least the last month
- Continuing buprenorphine with no plan to taper dose for the next 12 months
- Score of at least 1 on PHQ-2 during prescreen or score of greater than or equal to 8 on PHQ-9 during in person screening
- Gives informed consent to participate in the study.
Exclusion Criteria:
- Expected surgery in the next 3 months
- Pain thought to be due to cancer, infection, or inflammatory arthritis
- Greater than or equal to 10 days of cocaine/crack/methamphetamine use in the past month
- Current mania or past year psychosis as determined via SCID Module's A and B/C
- Lifetime diagnosis of schizophrenia or other chronic psychotic condition as determined by the study PI
- Moving within 12 months which would require a change in Buprenorphine provider
- SSDI or SSI claim pending
- Pregnancy or planned pregnancy in the next 6 months.
- Greater than 8 homeless nights in the past month
- Suicide ideation or behavior requiring immediate attention
- Not able to provide informed consent
- Not able to complete interviews in English
- Unable to provide names and contact information for at least two verifiable locator persons who will know where to find them in the future.
- Greater than or equal to 45 days without a phone in the past 3 months/no reliable access to phone
Sites / Locations
- Boston Medical CenterRecruiting
- Stanley Street Treatment and ResourcesRecruiting
Arms of the Study
Arm 1
Arm 2
Experimental
Active Comparator
Treating Opioid Patients' Pain and Sadness (TOPPS)
Health Education (HE)
TOPPS, consists of three main components: (1) psychoeducation about pain, depression, opioid use, their interactions, and the maintaining role of avoidance; (2) coaching in being an informed, activated patient (based in part on the chronic care model and on approaches to self-management of chronic illness); and (3) behavioral activation to increase engagement in meaningful activities.
After an initial, brief, joint, in-person meeting with the BHS and primary care physician (PCP), patients have a session that discusses nutrition. For the next 5 telephone sessions, they choose from a menu of topics, including: a second session on nutrition; germs, colds and the flu; preventing cancer; diabetes; protecting your heart; getting a good night's sleep; complementary and alternative medicine; caffeine, or physical activity.