Many patients with opioid use disorder or opioid misuse experience chronic pain. Despite this, little research has focused specifically on the overlap between these conditions. A team of researchers bridging the Yale Program in Addiction Medicine, the Yale Department of Psychiatry and the Yale School of Public Health were recently awarded an $11.8 million grant through the NIH Helping End Addiction Long-term (HEAL) initiative will support the establishment of a research center to advance integrated treatments for chronic pain and opioid use disorder or opioid misuse. Yale was one of just four such centers in the United States funded by the NIH through this initiative designed to form a larger Integrative Management of chronic Pain and OUD for Whole Recovery (IMPOWR) network.
William Becker, MD, Declan Barry, PhD, and David Fiellin, MD, are the Principal Investigators (PIs) on this grant, which will launch the Integrative Management of Chronic Pain and Opioid Use Disorder for Whole Recovery-Yale and Organizations United (IMPOWR-YOU) Research Center. The Center will be overseen by a Steering Committee comprising the PIs and several other Yale researchers, including Anne Black, PhD; Sarwat Chaudhry, MD; Theddeus Iheanacho, MBBS, DTM&H; Robert Kerns, PhD; Ryan McNeil, PhD; Rajita Sinha, PhD; and, Melissa Weimer, DO, MCR. Five cores, or working groups engaging key institutional and community partners, will focus on Operations, Engagement of Stakeholders and Persons with Lived Experience (PWLE), Career Development and Diversity, Pilot Projects, as well as Data and Measurement. Other collaborators include researchers at the APT Foundation, Howard University, the University of Puerto Rico, the University of Arkansas, University of Connecticut, the University of Colorado, and additional Yale School of Medicine colleagues.
The new Center will conduct two large studies alongside planned pilot projects and other Center activities. The first study, led by Becker, will compare the effectiveness of a pharmacist-led collaborative care model for patients prescribed long-term opioids who have opioid use disorder or opioid misuse and chronic pain versus the pharmacist program plus patient referral to a phone-delivered cognitive behavioral therapy (CBT)-based pain self-management program. The second study, led by Barry, will be situated within an opioid treatment program and compare, among patients receiving methadone or buprenorphine, the effectiveness of stepped care multimodal interdisciplinary chronic pain management including CBT, exercise and stress management.
Career development for early-stage investigators and those who are underrepresented in medicine, as well as engagement of PWLE, are among main priorities of the IMPOWR Centers. The Career Development and Diversity core will focus on involving associated early-stage investigators, fellows and postdoctoral associates, especially those from underrepresented groups, in the research and educational initiatives of the Center. The Stakeholders and PWLE core will direct efforts to ensure that all aspects of research design, conduct and dissemination are informed by stakeholders and PWLE. A sub-committee made up of PWLE of opioid use disorder or opioid misuse and chronic pain, as well as their caregivers, will be formed. The sub-committee will advise on research priorities and ethical considerations in conducting research with people with chronic pain, opioid use disorder or opioid misuse, and co-morbidities, including URGs, and will inform every step of the research process from design to sampling, recruitment, implementation, analysis, and dissemination.
Regarding prospective impact of the the IMPOWR-YOU Center, Becker shared: “This Center will allow Yale School of Medicine to capitalize on two of its strengths across departments, the treatment of opioid use disorder and chronic pain, using both medication and behavioral treatments. The IMPOWR-YOU Center will help Yale expand this groundbreaking research and bring together a multidisciplinary group of experts, persons with lived experience and key stakeholders.”
Other Yale researchers include Mark Beitel, PhD; Christopher Cutter, PhD; James Dziura, MPH, PhD; Sara Edmond, PhD; Denise Esserman, PhD; Kirsha Gordon, PhD, MS; Alexandra Hajduk, PhD, MPH; Alicia Heapy, PhD; and, Brent Moore, PhD.