Public health crisis and epidemic are words used to describe the problem of opioid use in the United States. These concerns are not limited just to people taking opioids recreationally or without a prescription. Nine million Americans report using opioids for medical reasons. In the last 20 years there has been a dramatic increase in long-term opioid therapy to treat chronic non-cancer pain, despite the lack of evidence for long-term efficacy. Therefore, a significant challenge facing physicians is what to do with chronic pain patients who were started on opioids for therapeutic reasons (i.e., pain relief), but continue taking them despite lost or absent benefit. An intervention for therapeutic opioid cessation must consider the ways chronic pain patients, who were prescribed opioids by a physician, differ from people with other types of addiction. To this end, subjective and objective data from patients and consultation with chronic pain and addiction experts will inform the development of an opioid cessation intervention based on a comprehensive model that addresses the unique cessation issues faced by chronic pain patients. This application consists of three research aims.
The first aim i ncludes qualitative assessment using focus groups to (1) identify the unique barriers (and facilitators) to opioid cessation, and (2) select topics and content to include in a cessation intervention. We hypothesize that chronic pain patients taking opioids will identify several distinct factors that influence the maintenance of opioids including perceptions about pain relief, underlying psychological/affective effects derived from opioids, and beliefs about addiction. These factors likely interact and contribute to motivation and self-efficacy for opioid cessation.
The second aim i s the development of a brief Individualized Opioid Cessation (IOC) program utilizing data from the focus groups, the expertise of the co-investigators, and patient and physician feedback. During the third aim, we will pilot test the IOC program in 80 patients with chronic pain who are using opioids and not receiving adequate benefit. We hypothesize that the IOC program will improve cessation outcomes in patients with chronic pain compared to a control group receiving standard care. This Mentored Patient-Oriented Career Development Award will provide the candidate with the in-depth training necessary to develop an independent research program for opioid cessation in patients with chronic pain who are not deriving benefit from this class of drugs. The career development plan outlined in this application has three primary components: (1) course work in neurobiology, (2) training in qualitative methodology and data analysis, (3) and training in intervention development and testing. This application is supported by a multidisciplinary mentorship team. Ultimately, this work will lead to a better understanding of why patients continue taking opioids and incorporate theory-based models of behavior change into the development of interventions for individuals who would benefit from opioid cessation.
Despite widespread use, there is little empirical evidence supporting long-term opioid therapy for chronic pain. Once a physician has determined that the therapeutic benefit of opioids is absent, few tools exist to help the patient achieve opioid cessation. The overarching goal of this application is to develop an Individualized Opioid Cessation (IOC) program that helps patients more effectively reduce opioid use when opioids fail to provide adequate pain relief.
| Neville, Stephen J; Clauw, Andrew D; Moser, Stephanie E et al. (2018) Association Between the 2011 Fibromyalgia Survey Criteria and Multisite Pain Sensitivity in Knee Osteoarthritis. Clin J Pain 34:909-917 |
| Lee, Jay S; Hu, Hsou M; Brummett, Chad M et al. (2017) Postoperative Opioid Prescribing and the Pain Scores on Hospital Consumer Assessment of Healthcare Providers and Systems Survey. JAMA 317:2013-2015 |
