The effect of a Life Care Specialist on pain management and opioid-related outcomes among patients with orthopedic trauma: study protocol for a randomized controlled trial

Nicholas A Giordano, Jesse Seilern Und Aspang, J'Lynn Baker, Cammie Wolf Rice, Bailey Barrell, Lauren Kirk, Erika Ortega, Michelle Wallace, Alaina Steck, Mara L Schenker, Nicholas A Giordano, Jesse Seilern Und Aspang, J'Lynn Baker, Cammie Wolf Rice, Bailey Barrell, Lauren Kirk, Erika Ortega, Michelle Wallace, Alaina Steck, Mara L Schenker

Abstract

Background: Orthopedic trauma patients face complex pain management needs and are frequently prescribed opioids, leaving them at-risk for prolonged opioid use. To date, post-trauma pain management research has placed little emphasis on individualized risk assessments for misuse and systematically implementing non-pharmacologic pain management strategies. Therefore, a community-academic partnership was formed to design a novel position in the healthcare field (Life Care Specialist (LCS)), who will educate patients on the risks of opioids, tapering usage, safe disposal practices, and harm reduction strategies. In addition, the LCS teaches patients behavior-based strategies for pain management, utilizing well-described techniques for coping and resilience. This study aims to determine the effects of LCS intervention on opioid utilization, pain control, and patient satisfaction in the aftermath of orthopedic trauma.

Methods: In total, 200 orthopedic trauma patients will be randomized to receive an intervention (LCS) or a standard-of-care control at an urban level 1 trauma center. All patients will be assessed with comprehensive social determinants of health and substance use surveys immediately after surgery (baseline). Follow-up assessments will be performed at 2, 6, and 12 weeks postoperatively, and will include pain medication utilization (morphine milligram equivalents), pain scores, and other substance use. In addition, overall patient wellness will be evaluated with objective actigraphy measures and patient-reported outcomes. Finally, a survey of patient understanding of risks of opioid use and misuse will be collected, to assess the influence of LCS opioid education.

Discussion: There is limited data on the role of individualized, multimodal, non-pharmacologic, behavioral-based pain management intervention in opioid-related risk-mitigation in high-risk populations, including the orthopedic trauma patients. The findings from this randomized controlled trial will provide scientific and clinical evidence on the efficacy and feasibility of the LCS intervention. Moreover, the final aim will provide early evidence into which patients benefit most from LCS intervention.

Trial registration: ClinicalTrials.gov NCT04154384 . Registered on 11/6/2019 (last updated on 6/10/2021).

Keywords: Life Care Specialist; Opioid epidemic; Opioid use disorder; Opioid utilization; Orthopedic trauma; Pain management; Patient-reported outcomes; Substance misuse.

Conflict of interest statement

The authors declare that they have no competing interests.

© 2021. The Author(s).

Figures

Fig. 1
Fig. 1
Life Care Specialist interventions
Fig. 2
Fig. 2
SPIRIT study schedule. EHR, Electronic health record data; LCS, Life Care Specialist; SDOH, Comprehensive Social Determinants of Health (SDOH) Survey; ORT, Revised Opioid Risk Tool; PMQ, Pain Management Questionnaire; PDUQ, Prescription Drug Use Questionnaire; PROMIS, Patient-Reported Outcomes Measurement Information System; PTSD, post-traumatic stress disorder; DSM-V, Diagnostic and Statistical Manual of Mental Disorders, 5th Edition; NRS, numeric rating scale. * Weeks after discharge ± 7 days

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