Efficacy of motivational-interviewing and guided opioid tapering support for patients undergoing orthopedic surgery (MI-Opioid Taper): A prospective, assessor-blind, randomized controlled pilot trial

Jennifer M Hah, Jodie A Trafton, Balasubramanian Narasimhan, Partha Krishnamurthy, Heather Hilmoe, Yasamin Sharifzadeh, James I Huddleston, Derek Amanatullah, William J Maloney, Stuart Goodman, Ian Carroll, Sean C Mackey, Jennifer M Hah, Jodie A Trafton, Balasubramanian Narasimhan, Partha Krishnamurthy, Heather Hilmoe, Yasamin Sharifzadeh, James I Huddleston, Derek Amanatullah, William J Maloney, Stuart Goodman, Ian Carroll, Sean C Mackey

Abstract

Background: Postoperative opioid use can lead to chronic use and misuse. Few studies have examined effective approaches to taper postoperative opioid use while maintaining adequate analgesia.

Methods: This randomized, assessor-blinded, pilot trial of postoperative motivational interviewing and guided opioid tapering support (MI-Opioid Taper) added to usual care (UC) enrolled patients undergoing total hip or knee arthroplasty at a single U.S. academic medical center. MI-Opioid Taper involved weekly (to seven weeks) and monthly (to one year) phone calls until patient-reported opioid cessation. Opioid tapering involved 25% weekly dose reductions. The primary feasibility outcome was study completion in the group to which participants were randomized. The primary efficacy outcome, time to baseline opioid use, was the first of five consecutive days of return to baseline preoperative dose. Intention-to-treat analysis with Cox proportional hazards regression was adjusted for operation. ClinicalTrials.gov registration: NCT02070003.

Findings: From November 26, 2014, to April 27, 2018, 209 patients were screened, and 104 patients were assigned to receive MI-Opioid Taper (49 patients) or UC only (55 patients). Study completion after randomization was similar between groups (96.4%, 53 patients receiving UC, 91.8%, 45 patients receiving MI-Opioid Taper). Patients receiving MI-Opioid Taper had a 62% increase in the rate of return to baseline opioid use after surgery (HR 1.62; 95%CI 1.06-2.46; p = 0•03). No trial-related adverse events occurred.

Interpretation: In patients undergoing total joint arthroplasty, MI-Opioid Taper is feasible and future research is needed to establish the efficacy of MI-Opioid Taper to promote postoperative opioid cessation.

Funding: National Institute on Drug Abuse.

Keywords: Chronic opioid use after surgery; Motivational interviewing; Opioid cessation; Opioid tapering; Opioid tapering support; Orthopedic; Pain cessation; Persistent postoperative opioid use; Randomized trial; Surgery; Surgical recovery; Total hip arthroplasty; Total knee arthroplasty; pilot study.

Conflict of interest statement

Dr. Hah reports grants from NIH NIDA, during the conduct of the study. Dr. Trafton reports other interests from Institute for Brain Potential outside the submitted work. Dr. Maloney reports other interests from Stryker, Zimmer, and grants from NIH outside the submitted work. Dr. Goodman reports personal fees from board membership, personal fees from consultancy, grants from NIH, grants from Omega, from Coulter, personal fees from payment for development of educational presentations, personal fees from stock/stock options outside the submitted work. Dr. Mackey reports grants from NIH NIDA, during the conduct of the study. All other authors have nothing to declare.

© 2020 The Authors.

Figures

Fig. 1
Fig. 1
Study flowchart.
Fig. 2
Fig. 2
Kaplan-Meier plot for time to baseline opioid use by treatment group, in days. The number of patients at risk (have not yet reduced their postoperative opioid use to preoperative levels) is given below the bottom axis.
Fig. 3
Fig. 3
Kaplan-Meier plot for time to complete opioid cessation by treatment group, in days. The number of patients at risk (have not yet discontinued postoperative opioid use) is given below the bottom axis.

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Source: PubMed

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