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.

National Institute of Health (NIH)
National Institute on Drug Abuse (NIDA)
Mentored Patient-Oriented Research Career Development Award (K23)
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Special Emphasis Panel (ZRG1-RPIA-N (09))
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Aklin, Will
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Stanford University
Schools of Medicine
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Sturgeon, John A; Hah, Jennifer M; Sharifzadeh, Yasamin et al. (2018) Predictors of Daily Pain Medication Use in Individuals with Recurrent Back Pain. Int J Behav Med 25:252-258
Hah, Jennifer; Mackey, Sean C; Schmidt, Peter et al. (2018) Effect of Perioperative Gabapentin on Postoperative Pain Resolution and Opioid Cessation in a Mixed Surgical Cohort: A Randomized Clinical Trial. JAMA Surg 153:303-311
Hah, Jennifer M; Sturgeon, John A; Zocca, Jennifer et al. (2017) Factors associated with prescription opioid misuse in a cross-sectional cohort of patients with chronic non-cancer pain. J Pain Res 10:979-987
Hah, Jennifer M; Bateman, Brian T; Ratliff, John et al. (2017) Chronic Opioid Use After Surgery: Implications for Perioperative Management in the Face of the Opioid Epidemic. Anesth Analg 125:1733-1740
Tedesco, Dario; Asch, Steven M; Curtin, Catherine et al. (2017) Opioid Abuse And Poisoning: Trends In Inpatient And Emergency Department Discharges. Health Aff (Millwood) 36:1748-1753
Hah, Jennifer (2016) Taking adolescent prescription opioid use in context: risk stratification in early mid-life based on medical and nonmedical use. Pain 157:2143-4
Hah, Jennifer M; Sharifzadeh, Yasamin; Wang, Bing M et al. (2015) Factors Associated with Opioid Use in a Cohort of Patients Presenting for Surgery. Pain Res Treat 2015:829696
Carroll, Ian R; Hah, Jennifer M; Barelka, Peter L et al. (2015) Pain Duration and Resolution following Surgery: An Inception Cohort Study. Pain Med 16:2386-96
Chapin, Heather L; Darnall, Beth D; Seppala, Emma M et al. (2014) Pilot study of a compassion meditation intervention in chronic pain. J Compassionate Health Care 1:
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

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