This Mentored Patient-Oriented Research Career Development Award (K23) will support Dr. Jennifer Hah?s research and training in clinical research related to understanding the relationship between psychological factors, persistent opioid use, and pain after surgery. Forty-five million Americans undergo surgery every year with resulting acute pain and prescription opioid use;and iatrogenic opioid exposure is an important instigator of prescription opioid addiction. Dr. Hah has a background in anesthesiology, pain medicine, and epidemiology. She will gain further training in aspects of pain, psychology, and addiction research. Our previous research has identified pre-operative elevated depressive symptoms as a predictor of delayed opioid cessation after surgery. Transient mood stabilization at peak opioid doses may perpetuate opioid use in patients with pre-existing emotional distress. A critical knowledge gap exists regarding how mood relates to pain and opioid use through surgery and recovery. The first research aim of this proposal is to characterize the relationship between changes in emotional distress, opioid use, and pain throughout surgery and recovery. Baseline and longitudinal assessments of emotional distress, affect, opioid use, opioid misuse, and pain will be obtained. Dr. Hah will use the NIH Patient-Reported Outcomes Measurement Information System (PROMIS) item banks for emotional distress and computerized adaptive testing as part of longitudinal data collection. Use of the NIH PROMIS will facilitate capturing real-time changes in emotional distress, as it relates to opioid use and pain, in a way that has never been accomplished after surgery. The second research aim is to compare motivational interviewing and physician-guided opioid weaning vs. usual care after surgery to reduce persistent opioid use. This brief psychological intervention will address the epidemic of prescription opioid abuse by attempting to prevent the occurrence of persistent opioid use after surgery. The current standard opioid prescription coupled with instructions to cease opioid use upon pain resolution is inadequate to address the risks of persistent opioid use, misuse, and abuse. We propose a novel psychological intervention, which includes a physician-guided opioid weaning protocol of 25% of the total opioid dose every seven days. Patients will be concurrently monitored for increasing pain and opioid withdrawal symptoms. Our research may result in a major shift in clinical practice drawing more attention to proper opioid management during recovery. Furthermore, no studies have examined optimal opioid management and tapering strategies for patients recovering from surgery. Overall, the proposed research will advance knowledge regarding the role of psychological factors in delaying opioid cessation after surgery. Based on the results of the proposed research, Dr. Hah plans to apply for independent funding to develop non-pharmacologic interventions to decrease psychological risk factors of persistent opioid use and misuse after surgery.

Public Health Relevance

This training award will develop Dr. Hah as an independent patient-oriented researcher in the fields of pain, psychology, and addiction. Her research will focus on the relationships between psychological factors, opioid use, and pain throughout surgery and recovery. She will also evaluate physician-guided opioid weaning through motivational interviewing as a brief non-medication intervention to promote opioid cessation after surgery.

Agency
National Institute of Health (NIH)
Institute
National Institute on Drug Abuse (NIDA)
Type
Mentored Patient-Oriented Research Career Development Award (K23)
Project #
1K23DA035302-01
Application #
8487036
Study Section
Special Emphasis Panel (ZRG1-RPIA-N (09))
Program Officer
Aklin, Will
Project Start
2013-04-15
Project End
2018-03-31
Budget Start
2013-04-15
Budget End
2014-03-31
Support Year
1
Fiscal Year
2013
Total Cost
$180,649
Indirect Cost
$13,381
Name
Stanford University
Department
Anesthesiology
Type
Schools of Medicine
DUNS #
009214214
City
Stanford
State
CA
Country
United States
Zip Code
94305
Hah, Jennifer M; Mackey, Sean; Barelka, Peter L et al. (2014) Self-loathing aspects of depression reduce postoperative opioid cessation rate. Pain Med 15:954-64