Reducing Opioid-Related Harms to Treat Chronic Pain (IMPOWR and MIRHIQL)

Overview

The Research Need

In the United States, 13 million Americans experience physical dependence from long-term use of opioids for chronic pain management, 8.7 million individuals exhibit signs of opioid misuse, and 5.5 million individuals have opioid use disorder (OUD). Nearly half of people who have OUD also experience chronic pain, and for a subset of patients, opioid risks outweigh therapeutic benefit. Although evidence-based interventions exist for both conditions, less is known about effective strategies to treat opioid related harms and chronic pain simultaneously. Systems providing care for these populations are often fragmented, have limited resources and expertise, and are impeded by communication barriers.

About the Programs

The Integrative Management of chronic Pain and OUD for Whole Recovery (IMPOWR) program develops and tests combined interventions such as psychotherapy, medications for OUD, exercise, and pain self-management. These interventions are embedded within specific health care system settings and with a holistic, whole-patient focus. The network collaborates with individuals with lived/living experience and public/private partners to examine implementation factors such as financing and organizational barriers.

The Multilevel Interventions to Reduce Harm and Improve Quality of Life for Patients on Long Term Opioid Therapy (MIRHIQL) program supports research to reduce harm and improve the quality of life of people with chronic pain who take opioids long-term. This research develops interventions for patients as well as strategies for health care providers and health systems who help manage the care of these patients. In addition, this program creates resources for research and clinical practice, including a clinical definition for individuals taking opioids long-term for whom opioid risks outweigh benefits. Specifically, this research effort will identify symptoms/behaviors for individuals on long-term opioid therapy when opioid harms outweigh benefits, create a name for this clinical scenario, generate a screening assessment for it, and validate this definition in a prospective, independent sample. These efforts are guided by input from the MIRHIQL Partner Consultation Board.

Open Funding Opportunities

There are no Open Funding Opportunities at this time.

Program Details

To date, through the Helping to End Addiction Long-term® Initiative, or NIH HEAL Initiative®, NIH has awarded $53 million to fund these two initiatives. All projects are co-led by collaborative teams of experienced and early stage investigators, in partnership with people with lived experience and public/private partners (e.g., payors, caretakers, health care providers from multiple disciplines, policymakers, advocacy groups, or professional organizations).

Research Examples

Research examples supported by this program include:  

  • Evaluating the effectiveness of buprenorphine microdosing and flexible dosing to treat co-occurring chronic pain and opioid use disorder
  • Determining the effectiveness of collaborative care, care management, and stepped care approaches for sustaining treatment for chronic pain and opioid use disorder
  • Combining pain-targeted psychotherapy or exercise with medications for opioid use disorder 
  • Developing a composite screening tool for chronic pain and opioid use disorder
  • Identifying flexible, safe, and patient-centered schedules and strategies to slowly reduce opioid doses, alone or in combination with other pharmacologic and nonpharmacologic therapies
  • Creating a risk-benefit decision tool to assist providers in determining when opioids should be continued, tapered, or tapered and discontinued
  • Creating and validating a clinical definition for individuals taking opioids long-term for whom opioid risks outweigh benefits (name, associated behaviors and symptoms, and a screening assessment)

Common Data Elements (CDEs)

All of the trials funded under both initiatives are collecting harmonized common data elements (CDEs). CDEs are defined fields describing the data to be collected (e.g., identifying specific variables) along with how to gather the data (e.g., patient-reported outcomes, or PROs), and how the response is represented in a dataset (e.g., allowable responses or variable coding). CDEs are structured as indivisible units of data. This can be either an individual field (e.g., sex) or multiple fields taken together (e.g., the composite score of a scale). A CDE can be used in multiple clinical studies, with content standards that can be applied to different data collection models that are dynamic and may evolve over time. CDEs enable interoperability among data systems. 

With input from our partners with lived experience, public/private partners, and research experts from each of the awarded centers, the IMPOWR network developed a comprehensive list of patient-reported outcomes to capture whole recovery. The required CDEs integrates the HEAL CDEs for chronic pain. Since this initiative is intended to address both chronic pain and opioid misuse/OUD, this population may hold particular interest for the broader HEAL research community. As a resource, the IMPOWR CDEs are publicly available to enable meta-data and secondary data analysis. The database of CDEs and associated case-report forms (questionnaires) are available upon request. Please contact Laura Wandner, Ph.D., in the Office of Pain Policy and Planning at the National Institute of Neurological Disorders and Stroke, for more information.

DomainCDE
Demographics
  • Race, gender, sex identity
  • Income
  • Education
  • Multidimensional Scale of Perceived Social Support (MSPSS)
  • HEAL Chronic Pain CDE Disability
Chronic Pain
  • HEAL Chronic Pain CDE Screening Questions
  • Chronic Pain categorization
  • Michigan Body Map
  • PGIC
  • PEG
  • PCS-6
  • Pain Interference
  • Pain Intensity
  • PROMIS Physical Functioning
Quality of Life (PROMIS PROPr)
  • Fatigue
  • Cognitive Function
  • Social Function
  • Anxiety
  • Depression
  • HEAL Chronic Pain CDE Sleep Duration
  • Sleep Function 6a
Substance Use
  • Addiction Severity Index
  • Opioid Misuse (via PROMIS opioid misuse item bank)
  • TAPS-1
  • Tobacco Use (including electronic cigarette use)
  • Cannabis Use
  • Alcohol Use (AUDIT-US-C)
  • MOUD Use
  • Overdose
  • Social Drug Use
PTSD/Trauma
  • PC-PTSD-5
General Anxiety Disorder
  • GAD-2
Major Depressive Disorder
  • PHQ3
COVID/COVID impact
  • IMPOWR derived items on COVID-19
Discrimination/Stigma
  • Substance Use Stigma Mechanism Scale
  • Perceived Discrimination Scale
Social Determinants of Health
  • Social Risk Assessment Questionnaire
Cost-effectiveness analyses
  • IMPOWR-derived items on utilization of health services and health economics
Implementation Outcomes: Patient-facing
  • Health Literacy
  • Treatment Satisfaction
  • CollaboRATE Shared Decision Making
Implementation Outcomes: Provider-facing
  • Acceptability of Intervention Measure (AIM)
  • Intervention Appropriateness Measure (IAM)
  • Feasibility of Intervention Measure (FIM)
  • Readiness for Organizational Change (ROC)

  • Albert Einstein College of Medicine – New York (IMPOWR)
  • Medical University of South Carolina – South Carolina (MIRHIQL) 
  • Stanford University – California (MIRHIQL) 
  • University of New Mexico – New Mexico (IMPOWR)
  • University of Pittsburgh at Pittsburgh – Pennsylvania (IMPOWR)
  • University of Utah – Utah (MIRHIQL) 
  • Wake Forest University Health Sciences – North Carolina (IMPOWR & MIRHIQL)
  • Yale University  – Connecticut (IMPOWR & MIRHIQL)

2023
MIRHIQL Resource Center (MRC) for Improving Quality of Life with Chronic Pain
Summary
Summary
Sep 28, 2023
2023
Integrating Tailored Postoperative Opioid Tapering and Pain Management Support for Patients on Long-Term Opioid Use Presenting for Spine Surgery (MIRHIQL)
Summary
Summary
Sep 28, 2023
2023
Multilevel Interventions to Reduce Harm and Improve Quality of Life for Patients on Long-Term Opioid Therapy - Yale Resource Center (MIRHIQL-YRC)
Summary
Summary
Sep 28, 2023
2023
Sequential Trial of Adding Buprenorphine, Cognitive Behavioral Treatment, and Transcranial Magnetic Stimulation to Improve Outcomes of Long-Term Opioid Therapy for Chronic Pain (ACTION)
Summary
Summary
Sep 28, 2023
2023
Optimizing Patient-Centered Opioid Tapering with Mindfulness-Oriented Recovery Enhancement (MORE)
Summary
Summary
Sep 28, 2023

Contact

Shelley Su, Ph.D., NIDA 

Participating NIH Institutes, Centers, and Offices

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