The opioid epidemic is a serious national crisis that affects public health as well as social and economic welfare, with increasing and alarming mortality rates in the United States. Consequently, there is an urgent need for effective and efficient interventions to address opioid use to prevent the risk of opioid misuse and better address it once it is established. One of the greatest predictors for increased opioid use among patients with chronic pain is pain catastrophizing (PC), defined as persistent negative cognitive and emotional responses to actual or anticipated pain. Untreated PC can lead to increased opioid use and facilitate the risk for misuse and overuse of medications, particularly when surgery and pharmacologics are the focal medical care plan. Despite critical need, there are no targeted interventions that efficiently address the key psychological factors that can amplify both pain, need for opioids, and increased risk for misuse. In this mentored career development award (K23), Dr. Ziadni will attempt to address this urgent need for efficient and effective solutions. Our group has developed a 2-hour targeted, single-session pain catastrophizing class (PC- class), rooted in cognitive-behavior therapy (CBT) approaches, aimed at reducing opioid use by reducing pain catastrophizing in chronic pain. This targeted, brief treatment obviates many of the existing barriers and burdens to usual comprehensive pain-CBT, such as the time required to attend 8 sessions, insurance coverage, travel costs, lack of skilled clinicians, patient attrition, and copayments. Dr. Ziadni proposes to implement a randomized controlled trial comparing the PC-class to a health education control class.
In Aim 1, Dr. Ziadni will determine the efficacy of the PC class in reducing opioid use among patients with mixed-etiology pain conditions.
For Aim 2, she will collect daily data that will allow the conduct of analyses on the daily experience of catastrophizing and how it relates to opioid use, as well as its dynamic response to treatment. She will use this daily data to characterize the mechanistic influence of catastrophizing on opioid use both on the daily-level and prospectively. Patient outcomes will be longitudinally tracked at 1, 3, 6, and 12 months after the intervention session. This project aims to identify patients who achieve a meaningful reduction in opioid use, which will enable better characterization of treatment responders and refining opioid reduction strategies. Throughout the award period, Dr. Ziadni will obtain new skills and expertise in the mechanistic science of opioid use, the conduct of randomized controlled trials, and the neurobiological mechanisms of pain, opioids and addiction. To accomplish the proposed research and training, Dr. Ziadni has assembled a multi- disciplinary team of world-class mentors who are committed to her success. This training will build on Dr. Ziadni?s background in clinical psychology and doctoral research training in pain medicine and ultimately provide her with the knowledge and skillset to establish an independent research program.
Prescription opioids are one of the most commonly used treatments for chronic pain, despite limited evidence of their efficacy and high morbidity and mortality risks. Here, we aim to determine the efficacy of a targeted single-session psychology class in reducing opioid use among patients with chronic pain. The information gained from this study has the potential to identify patients who achieve a meaningful reduction in opioid use and inform opioid reduction strategies.
