The BRANCH program will extend TREETOP to support innovation in chronic pain and OUD clinical research and foster the careers of early-stage investigators from diverse backgrounds. The successful execution of the 3 initial pilot studies will inform our assessment of pain (both in TREETOP studies and potentially across the IMPOWR Network and HEAL Initiative), obtain additional insight into implementation of chronic pain and OUD management in specialty settings, and increase our awareness and understanding of how to reduce stigma and improve health equity in the care of patients with chronic pain and OUD. Future pilot projects will further expand the impact of the TREETOP Center. We envision all pilot projects supported by TREETOP as advancing to independent research projects, either through separate R- series funding or as large research projects in TREETOP’s renewal application.
Funded Projects
- PINE - Painimation: Initial validation study of a Novel Electronic assessment tool in OUD
-
Specific Aims
- Aim 1: Determine the ability of Painimation to assess pain intensity, pain type, and pain interference among patients presenting with OUD symptoms.
- Aim 2: Examine potential race/ethnicity, education level, geography, age, and gender differences in the validity of Painimation.
Pain is complex and multidimensional making it a challenge to measure in any context, but particularly difficult to assess in the presence of language barriers and culturally diverse patient populations. Indeed, culturally biased pain assessment, influenced by racial stereotypes, is a major cause of disparities in pain treatment.
Pain assessment may be especially complicated in the context of OUD, where factors such as hypersensitivity, hyperalgesia, or withdrawal not only interfere with pain perception, but may encourage individuals to report their pain based on what is most socially desirable, avoids stigma, or achieves their desired outcome (e.g., getting clinicians to take their pain/opioid needs seriously). To overcome these barriers, we developed Painimation, a technology-based method for addressing pain that employs human-centered design to allow patients to visualize and communicate their pain through individualized animations.
- BIRCHeS - Barriers to Implementing tReatment for Chronic pain and OUD in Hepatology, rheumatology, and infectious disease Settings
-
Specific Aims
- Aim 1: Evaluate the perceived barriers to implementing evidence-based chronic pain and OUD management in high-need subspecialty settings.
- Aim 2: Develop a provider-and system-facing implementation bundle to support subspecialists in implementing an OUD and pain management program in their settings.
Addressing persistent disparities in access to evidence-based chronic pain and OUD treatment requires a proactive, patient-centered approach that meets patients where they receive care. For those with complex, chronic conditions that’s often in a specialty care setting. For example, hepatologists often provide the regular medical care for individuals with cirrhosis, becoming the de facto primary care providers for this population, 85% of whom experience chronic pain and require frequent prescriptions for opioid analgesia despite coexisting OUD. With access to high quality pain and OUD care often severely restricted, especially for populations that are rural, non-White, or economically disadvantaged, we must consider novel implementation settings and approaches. BIRCHeS posits that these known barriers to chronic pain and OUD management may be best overcome in the specialty clinics where patients with complex medical conditions are already receiving care.
- CHERRI - Chronic pain and OUD: Health-Equity focused stigma Reduction through a Rapidly developed Intervention
-
Specific Aims
- Aim 1: Examine how hospitalized patients with OUD and chronic pain experience stigma in the hospital setting and how it impacts clinical care.
- Aim 2: Develop a multi-level intervention to reduce stigma and improve co-management of OUD and pain among hospitalized patients.
Stigma from healthcare clinicians, and embedded within the healthcare system, negatively impacts quality of care for hospitalized patients with OUD and chronic pain and can lead to acute and long-term negative health outcomes. For example, stigma causes clinicians to underestimate the efficacy of evidence-based treatment for OUD, to undertreat or ignore co-occurring pain, and to implicitly or explicitly create environments where patients feel unwelcome. In turn, patients with undertreated or underassessed pain are at increased risk for leaving the hospital against medical advice, returning to illicit substance use, and developing persistent pain, all of which lead to poor health outcomes. This may be especially true for Black patients as stigma toward OUD is compounded by racial bias. Effective, targeted interventions to eliminate clinician and health system stigma toward hospitalized patients with OUD and chronic pain, particularly Black patients, are urgently needed.