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In pilot studies of patients with OUD receiving buprenorphine or methadone who had CP, cognitive behavioral therapy (CBT) attenuated nonmedical opioid use compared with treatment-as-usual (TAU), but patients in both treatment arms exhibited similar pain improvements. Adding exercise and stress reduction to this model may augment pain-related outcomes. With funding from National Institutes of Health, we plan to conduct a randomized clinical trial of 316 patients with OUD and CP to test the effectiveness of TAU compared with Stepped Care for Patients to Optimize Whole Recovery (SC-POWR) to reduce nonmedical opioid use and pain (primary outcomes) (Aim 1) and decrease pain intensity and interference, alcohol use, anxiety, depression and stress, and improve sleep (secondary outcomes) (Aim 2). Eligible participants will be randomized to receive TAU (buprenorphine or methadone and at least once a month individual or group counseling) or SC-POWR (ie, TAU and up to 12 CBT sessions) for 24\u2009weeks. Based on prespecified nonresponse criteria, SC-POWR may be stepped up at week 6 to receive onsite weekly group sessions of exercise (Wii Fit, Tai Chi) and \u201cstepped up\u201d again at week 15 to receive weekly group sessions of stress reduction (relaxation training, auricular acupuncture). They will be followed for another 24\u2009weeks to evaluate durability of treatment response for illicit opioid use, alcohol use, pain, anxiety, depression, stress, sleep, and retention in medications for OUD (Aim 3).<\/jats:p>","DOI":"10.1177\/29767342241245095","type":"journal-article","created":{"date-parts":[[2024,4,12]],"date-time":"2024-04-12T08:20:06Z","timestamp":1712910006000},"page":"146-154","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":3,"title":["Stepped Care for Patients to Optimize Whole Recovery (SC-POWR): An Effectiveness Trial Evaluating a Stepped Care Model for Individuals With Opioid Use Disorder and Chronic Pain"],"prefix":"10.1177","volume":"46","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6898-2192","authenticated-orcid":false,"given":"Raiza","family":"Rossi","sequence":"first","affiliation":[{"name":"Internal Medicine, Yale School of Medicine, New Haven, CT, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Christopher J.","family":"Cutter","sequence":"additional","affiliation":[{"name":"Yale Child Study Center, New Haven, CT, USA"},{"name":"Yale Program in Addiction Medicine, Yale School of Medicine, New Haven, CT, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mark","family":"Beitel","sequence":"additional","affiliation":[{"name":"Yale Child Study Center, New Haven, CT, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mikah","family":"Covelli","sequence":"additional","affiliation":[{"name":"APT Foundation, New Haven, CT, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"David A.","family":"Fiellin","sequence":"additional","affiliation":[{"name":"Internal Medicine, Yale School of Medicine, New Haven, CT, USA"},{"name":"Yale Program in Addiction Medicine, Yale School of Medicine, New Haven, CT, USA"},{"name":"Department of Emergency Medicine, Yale School of Medicine, New Haven, CT, USA"},{"name":"Department of Health Policy and Management, Yale School of Public Health, New Haven, CT, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Robert D.","family":"Kerns","sequence":"additional","affiliation":[{"name":"Yale Program in Addiction Medicine, Yale School of Medicine, New Haven, CT, USA"},{"name":"Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-7739-5434","authenticated-orcid":false,"given":"Svetlana","family":"Vassilieva","sequence":"additional","affiliation":[{"name":"Internal Medicine, Yale School of Medicine, New Haven, CT, USA"},{"name":"Yale Program in Addiction Medicine, Yale School of Medicine, New Haven, CT, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Deborah","family":"Olabisi","sequence":"additional","affiliation":[{"name":"APT Foundation, New Haven, CT, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6697-5220","authenticated-orcid":false,"given":"Declan T.","family":"Barry","sequence":"additional","affiliation":[{"name":"Yale Child Study Center, New Haven, CT, USA"},{"name":"Yale Program in Addiction Medicine, Yale School of Medicine, New Haven, CT, USA"},{"name":"APT Foundation, New Haven, CT, USA"},{"name":"Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"179","published-online":{"date-parts":[[2024,4,12]]},"reference":[{"key":"e_1_3_2_2_2","doi-asserted-by":"publisher","DOI":"10.1001\/jama.289.18.2370"},{"key":"e_1_3_2_3_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0885-3924(99)00144-X"},{"key":"e_1_3_2_4_2","doi-asserted-by":"publisher","DOI":"10.15585\/mmwr.mm6736a2"},{"key":"e_1_3_2_5_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.pain.2004.11.011"},{"key":"e_1_3_2_6_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.drugalcdep.2015.10.018"},{"key":"e_1_3_2_7_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.drugalcdep.2014.10.023"},{"key":"e_1_3_2_8_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpain.2020.01.005"},{"key":"e_1_3_2_9_2","doi-asserted-by":"publisher","DOI":"10.1097\/AJP.0000000000000855"},{"key":"e_1_3_2_10_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.bja.2018.09.019"},{"key":"e_1_3_2_11_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1521-0391.2012.00293.x"},{"key":"e_1_3_2_12_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.drugalcdep.2012.08.003"},{"key":"e_1_3_2_13_2","doi-asserted-by":"crossref","DOI":"10.1016\/j.jsat.2009.12.007","article-title":"Pain and continued opioid use in individuals receiving buprenorphine-naloxone for opioid detoxification: secondary analyses from the Clinical Trials Network","volume":"38","author":"Potter JS","year":"2010","unstructured":"Potter JS, Chakrabarti A, Domier CP, Hillhouse MP, Weiss RD, Ling W. 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