# Opioid Dose Reduction in Comprehensive Inpatient Rehabilitation: A pharmaco-behavioral approach

> **NIH NIH K23** · SPAULDING REHABILITATION HOSPITAL · 2022 · $161,858

## Abstract

PROJECT SUMMARY
This K23 career development award will position the candidate to become an independent clinical researcher
with expertise in refining and testing pharmaco-behavioral interventions for pain management in patients under
intensive rehabilitation. BACKGROUND. Pain is a significant problem for inpatients, and opioids are often used
as a part of their analgesic treatment approach. Unfortunately, adequate pain relief by narcotic comes with
adverse effects and risk of addiction. Overall, opioid usage for those in Comprehensive Inpatient Rehabilitation
(CIR) is high due to the complexity of their injuries. Notably, pain in rehabilitation leads to worsened clinical
outcomes, due to maladaptive healthcare engagement (e.g., avoidance or overuse of physical therapy). It is
critical to developing evidence-based pharmaco-behavioral interventions, and Conditioning Open-Label Placebo
(COLP) is a promising technique for reducing opioid use in CIR. Based on principles of classical conditioning,
COLP takes advantage of opioids pharmacology to promote learned responses for evoked placebo-driven
analgesia. SPECIFIC AIMS. The proposed studies employ mixed methods designs to: (1) evaluate, in a pilot
randomized clinical trial (RCT), the feasibility and acceptability of COLP for patients with pain in CIR, (2) explore
neurophysiological mechanisms and markers associated with COLP, and (3) explore within-group longitudinal
patterns of pain management and their covariance across multiple timepoints. TRAINING. The candidate will
achieve short-term goals through a resource-rich institutional environment and a cohesive training plan in (1)
clinical trial design in CIR, (2) neurophysiology and signal analysis and longitudinal data collection, and (3)
evaluation of pain management, including; beliefs, expectations, and attitudes toward the treatment. In addition
to ongoing mentorship meetings and experiential training through the research plan, the candidate will complete
targeted coursework, didactic training, and clinical shadowing. Presentations at local/national conferences, and
publish in peer-reviewed journals, are activities also included in candidate’s training. MENTORSHIP. The
candidate will be supported by a stellar mentoring team: Ross Zafonte, DO (primary mentor), Ted Kaptchuk
(primary mentor) Gloria Y. Yeh, MD, MPH (co-mentor), Christine Sang, MD, MPH (co-mentor), Kevin O’Connor,
MD (consultant), and Jeffrey Schneider (consultant). IMPACT. In line with NCMRR funding priorities, the
proposed research will answer critical questions about (1) the feasibility and acceptability of a multimodal
approach involving pharmaco-behavioral interventions for hard-to-manage symptoms and (2) develop objective
biomarkers associated with the experimental intervention. While the initial clinical trial will focus on pain in CIR,
it is anticipated that the candidate’s training and research will have broad applications to a variety of medical
populations struggling with p...

## Key facts

- **NIH application ID:** 10465286
- **Project number:** 5K23DA052041-02
- **Recipient organization:** SPAULDING REHABILITATION HOSPITAL
- **Principal Investigator:** Jorge Leon Morales-Quezada
- **Activity code:** K23 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2022
- **Award amount:** $161,858
- **Award type:** 5
- **Project period:** 2021-08-15 → 2026-07-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10465286

## Citation

> US National Institutes of Health, RePORTER application 10465286, Opioid Dose Reduction in Comprehensive Inpatient Rehabilitation: A pharmaco-behavioral approach (5K23DA052041-02). Retrieved via AI Analytics 2026-05-22 from https://api.ai-analytics.org/grant/nih/10465286. Licensed CC0.

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