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NIH grant 1I01RD000376-01A1: Improving pain and functioning using an integrative digital treatment for chronic pain and addiction in Veterans with opioid use disorder receiving buprenorphine
Institute: {'code': 'VA', 'abbreviation': 'VA', 'name': 'Veterans Affairs', 'admin_org_id': '12500964', 'admin_funding_url': ''}. PI: Alicia Heapy. Award: $.
Start: 2026-10-01T00:00:00.
Significance to VA: Opioid use disorder (OUD) is a significant public health problem associated with severe
harms including overdose and death. Negative outcomes are substantially reduced by medications for opioid
use disorder (MOUD), including methadone and buprenorphine, but retention in MOUD remains a challenge.
Chronic pain is a common co-occurring condition in this population and is associated with negative MOUD
outcomes including dropout, relapse, and increased cravings. Despite the high prevalence of chronic pain in
this population, integrated chronic pain and OUD treatments, including psychosocial treatments, re difficult to
obtain for Veterans with OUD receiving MOUD. Barriers to evidence-based psychosocial pain treatments
include stigma, patient travel limitations, the burden of frequent in-person sessions, scarcity of trained
therapists, and limited MOUD clinic resources. An integrated digital treatment for chronic pain and OUD that
can be completed at home may physical functioning, quality of life, and pain outcomes while addressing these
access barriers and reducing MOUD dropout, which increases the risk of opioid use and overdose.
Innovation & Impact: The Integrating the Management of Pain and Addiction via Collaborative Treatment
(IMPACT) is a 9-week, web-based treatment supplemented with daily digital surveys that inform personalized
weekly feedback messages for people with chronic pain and OUD receiving MOUD. IMPACT is an integration
of two previously tested technology-based interventions developed in an ongoing NIH-funded trial. Typically,
VHA pain treatment resources are greater than civilian healthcare settings; therefore, the comparator group
(enhanced treatment as usual or ETAU) in the current trial is a necessary step to rigorously test IMPACT
specifically within Veteran Health Administration (VHA) clinical care.
Specific Aims: Aim 1 is to determine whether IMPACT is superior to ETAU at 3-, 6-, and 9-months post-
enrollment on the following outcomes: pain interference (primary outcome), physical and psychological
functioning, mobility, sleep quality, and OUD outcomes (MOUD retention, adherence, and drug use). Among
Veterans randomized to IMPACT, we will also use daily survey data to explore the associations between daily
treatment engagement (skill use and daily steps) and daily pain interference and intensity ratings and
functional outcomes (socialization, recreation and work activity) (Aim 2). Aim 3 is to evaluate determinants of
IMPACT implementation guided by Consolidated Framework for Implementation Research and conduct a
summative evaluate at the clinic-, provider-, and patient-level guided by RE-AIM metrics. We will achieve this
through individual semi-structured interviews and evaluating the acceptability of and engagement in IMPACT
through system use metrics, treatment dose and attrition, and participant treatment credibility, expectancy, and
satisfaction ratings.
Methodology: The overall goal of this project is to conduct a randomized, hybrid type 1 effectiveness-
implementation trial comparing IMPACT to ETAU in Veterans with OUD and chronic pain receiving MOUD.
Path to Translation/Implementation: Data from this trial will be used to optimize IMPACT for a VHA
population and inform rapid scaling to support widespread use across VA facilities. IMPACT is offered remotely
using centralized staff, a treatment structure that has been shown to be feasible in multisite trials of
asynchronous pain treatment, so it can be integrated into existing MOUD clinical care with minimal burden on
clinic resources. IMPACT is in line with multiple VA priorities to increase access to evidence-based,
nonpharmacologic chronic pain treatment and immediately alleviate both Veteran and provider barriers to care.document fetched 2026-10-24 02:46