# Enhancing Exercise and Psychotherapy to Treat Comorbid Addiction and Pain for ImprovingAdherence to Medication Assisted Treatment in Opioid Use Disorders

> **NIH NIH R33** · CASE WESTERN RESERVE UNIVERSITY · 2022 · $944,737

## Abstract

PROJECT SUMMARY
Over 20.3 million adults in the U.S. are estimated to have a substance use disorder (SUD); and, an estimated
2 million Americans have had an opioid use disorder (OUD) involving prescription opioids and about 600,000
have had an OUD involving heroin. The number of overdose deaths from illicit opioids including heroin and
synthetic opioids has tripled from 2011 to 2015 in the U.S. Among the more than half-million adults entering
addiction treatment for prescription opioid abuse every year, 50%-60% report co-morbid chronic pain and 80%
report that pain triggers relapse. High rates of relapse are not surprising because substance misuse may
cause adverse structural and functional brain changes in the same brain regions that need to be engaged to
initiate recovery and maintain abstinence. Exercise has been shown to reduce substance cravings and reduce
depression and anxiety and may help reduce weight gain induced by methadone and anti-psychotic drug
treatments; and, exercise, particularly at higher intensities, may produce an analgesic effect improving pain
measures in chronic pain patients. Exercise may act by increasing growth and brain-derived neurotrophic
factors that stimulate endogenous dopaminergic, opioidergic and serotoninergic systems that, in turn, enhance
plasticity, learning and memory. These effects may help repair the structural and functional brain changes
caused by substance abuse and chronic pain and help “offset” reward seeking and craving of substances while
improving physical and mental health. However, most residential drug treatment programs do not currently
offer a structured exercise program. We have developed an ‘assisted’ exercise technology that enables active
patient engagement and mechanical assistance to help patients pedal faster than their voluntary rates. We
have previously shown that ‘assisted’ exercise on a stationary cycle provides global improvements in motor
function and increased activity in cortical and subcortical brain regions consistent with neural activation
patterns after applying a dopamine agonist in Parkinson’s disease patients, suggesting that ‘assisted’ exercise
may be modulating dopamine levels in the brain. In addition, we have shown that ‘assisted’ cycling improves
motor function and recovery in stroke patients. We have also developed a novel self-regulation/cognitive
behavioral therapy (CBT) program that co-addresses opioid addiction and pain (STOP), which has shown
efficacy on pain tolerance, cravings and functional engagement in daily activities in outpatients. In response to
RFA-AT-19-006, we propose to take a multi-phase optimization strategy (MOST) approach to refining our
intervention protocols and testing feasibility with our community partners (R61 Phase) and evaluating the
effects of exercise and I-STOP (STOP modified for inpatients) as adjunctive treatments to Medication Assisted
Treatment (MAT) in adults with an OUD and chronic pain enrolled in residential treatment progr...

## Key facts

- **NIH application ID:** 10578869
- **Project number:** 4R33AT010806-02
- **Recipient organization:** CASE WESTERN RESERVE UNIVERSITY
- **Principal Investigator:** Nora L. Nock
- **Activity code:** R33 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2022
- **Award amount:** $944,737
- **Award type:** 4N
- **Project period:** 2019-09-28 → 2025-05-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10578869

## Citation

> US National Institutes of Health, RePORTER application 10578869, Enhancing Exercise and Psychotherapy to Treat Comorbid Addiction and Pain for ImprovingAdherence to Medication Assisted Treatment in Opioid Use Disorders (4R33AT010806-02). Retrieved via AI Analytics 2026-06-02 from https://api.ai-analytics.org/grant/nih/10578869. Licensed CC0.

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