Integrative Management of chronic Pain and OUD for Whole Recovery (IMPOWR)

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healthcare provider talking to patient

Overview

The Research Need

It’s estimated that 40% to 60% of individuals who have an opioid use disorder (OUD) also experience chronic pain. Evidence-based interventions exist for both the treatment of pain and for the treatment of OUD. Yet less is known about effective strategies to meet the needs of people with OUD who also live with chronic pain. Systems providing care for these individuals are often fragmented, and suffer from limited resources, expertise, and communication. Further, more research is needed to better understand the effectiveness of integrated treatment plans, and the challenges and barriers toward sustained implementation. People with both pain and OUD often need tailored and integrative care to manage their overall health and support recovery.

About the Program

The NIH HEAL Initiative supports the Integrative Management of chronic Pain and OUD for Whole Recovery (IMPOWR) network of multidisciplinary team science collaborations to address the needs of people with pain and a substance use disorder. Research in the IMPOWR network will develop and test combined interventions such as psychotherapy, medications for opioid use disorder, exercise, and pain self-management in specific healthcare system settings. Research in the IMPOWR network will focus on the whole patient, recognizing the influence of stigma, health inequities, and co-occurring psychiatric disorders. Additionally, cost-effectiveness analyses, characterization of implementation barriers/solutions, and partnerships with important stakeholders will maximize the potential that the evidence-based interventions will be incorporated into standard practice.

Program Details

Through the NIH HEAL Initiative, NIH awarded grants to four research centers, each conducting two to three integrated clinical trials, as well as one resource coordinating center, totaling $19.7 million. All projects will be co-led by collaborative teams of experienced and early-stage investigators from diverse backgrounds, in partnership with people with lived experience and public/private partners (i.e., payors, caretakers, healthcare providers from multiple disciplines, policymakers, advocacy groups, or professional organizations).

Research Examples

The IMPOWR Network will establish integrated patient-centered treatment interventions and models of care delivery that reaches underserved communities such as African Americans, American Indian/Alaska Native, Hispanic/Latino, and rural populations. In total, the IMPOWR network will test nine unique interventions in primary care, opioid treatment programs, and hospital settings:

  • Evaluating the effectiveness of buprenorphine microdosing and flexible dosing to treat co-occurring chronic pain and OUD
  • Determining the effectiveness of collaborative care, care management, and stepped care approaches for sustaining treatment for chronic pain and OUD
  • Combining pain-targeted psychotherapy or exercise with medications for OUD
  • Developing a composite screening tool for chronic pain and OUD

IMPOWR Common Data Elements (CDEs)

All of the trials funded under this initiative will be 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., 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.

Domain CDE
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)

  • University of New Mexico – New Mexico
  • Yale University  – Connecticut
  • Albert Einstein College of Medicine – New York
  • University of Pittsburgh at Pittsburgh – Pennsylvania
  • Wake Forest University Health Sciences – North Carolina

Funded Projects

2021
Integrated Care for Chronic Pain and Opioid Use Disorder: The IMPOWR Research Center at Montefiore/Einstein (IMPOWR-ME)
Sep 20, 2021
2021
Integrative Treatment for Achieving Holistic Recovery from Comorbid Chronic Pain and Opioid Use Disorder
Sep 20, 2021
2021
Tailored Retention and Engagement for Equitable Treatment of OUD and Pain (TREETOP)
Sep 20, 2021
2021
HEAL Initiative: Integrative Management of Chronic Pain and OUD for Whole Recovery (IMPOWR): Research Centers
Sep 20, 2021
2021
Wake Forest IMPOWR Dissemination Education and Coordination Center (IDEA-CC)
Sep 20, 2021