"My Surgical Success": Effect of a Digital Behavioral Pain Medicine Intervention on Time to Opioid Cessation After Breast Cancer Surgery-A Pilot Randomized Controlled Clinical Trial

Beth D Darnall, Maisa S Ziadni, Parthasarathy Krishnamurthy, Pamela Flood, Lauren C Heathcote, Ian G Mackey, Chloe Jean Taub, Amanda Wheeler, Beth D Darnall, Maisa S Ziadni, Parthasarathy Krishnamurthy, Pamela Flood, Lauren C Heathcote, Ian G Mackey, Chloe Jean Taub, Amanda Wheeler

Abstract

Objective: This study aims to assess the feasibility of digital perioperative behavioral pain medicine intervention in breast cancer surgery and evaluate its impact on pain catastrophizing, pain, and opioid cessation after surgery.

Design and setting: A randomized controlled clinical trial was conducted at Stanford University (Palo Alto, CA, USA) comparing a digital behavioral pain medicine intervention ("My Surgical Success" [MSS]) with digital general health education (HE).

Participants: A convenience sample of 127 participants were randomized to treatment group. The analytic sample was 68 patients (N = 36 MSS, N = 32 HE).

Main outcomes: The primary outcome was feasibility and acceptability of a digital behavioral pain medicine intervention (80% threshold for acceptability items). Secondary outcomes were pain catastrophizing, past seven-day average pain intensity, and time to opioid cessation after surgery for patients who initiated opioid use.

Results: The attrition rate for MSS intervention (44%) was notably higher than for HE controls (18%), but it was lower than typical attrition rates for e-health interventions (60-80%). Despite greater attrition for MSS, feasibility was demonstrated for the 56% of MSS engagers, and the 80% threshold for acceptability was met. We observed a floor effect for baseline pain catastrophizing, and no significant group differences were found for postsurgical pain catastrophizing or pain intensity. MSS was associated with 86% increased odds of opioid cessation within the 12-week study period relative to HE controls (hazard ratio = 1.86, 95% confidence interval = 1.12-3.10, P = 0.016).

Conclusions: Fifty-six percent of patients assigned to MSS engaged with the online platform and reported high satisfaction. MSS was associated with significantly accelerated opioid cessation after surgery (five-day difference) with no difference in pain report relative to controls. Perioperative digital behavioral pain medicine may be a low-cost, accessible adjunct that could promote opioid cessation after breast cancer surgery.

Trial registration: ClinicalTrials.gov NCT03076190.

Keywords: Acute pain; Behavioral medicine; Digital; Surgery; psychology.

© 2019 American Academy of Pain Medicine.

Figures

Figure 1
Figure 1
Consort flow diagram.
Figure 2
Figure 2
Kaplan-Meier survival curve for opioid cessation under “My Surgical Success” vs health education material control.

References

    1. Sun EC, Darnall BD, Baker LC, Mackey S.. Incidence of and risk factors for chronic opioid use among opioid-naive patients in the postoperative period. JAMA Intern Med 2016;1769:1286–93.
    1. Brummett CM, Waljee JF, Goesling J, et al. New persistent opioid use after minor and major surgical procedures in US adults. JAMA Surg 2017;1526:e170504.
    1. Marcusa DP, Mann RA, Cron DC, et al. Prescription opioid use among opioid-naive women undergoing immediate breast reconstruction. Plast Reconstr Surg 2017;1406:1081–90.
    1. Helmerhorst GT, Vranceanu A-M, Vrahas M, Smith M, Ring D.. Risk factors for continued opioid use one to two months after surgery for musculoskeletal trauma. JBJS 2014;966:495–9.
    1. Komatsu R, Carvalho B, Flood P.. Prediction of outliers in pain, analgesia requirement, and recovery of function after childbirth: A prospective observational cohort study. Br J Anaesth 2018;1212:417–26.
    1. Ehde DM, Dillworth TM, Turner JA.. Cognitive-behavioral therapy for individuals with chronic pain: Efficacy, innovations, and directions for research. Am Psychol. 2014;69(2):153–66.
    1. Naylor MR, Naud S, Keefe FJ, Helzer JE.. Therapeutic Interactive Voice Response (TIVR) to reduce analgesic medication use for chronic pain management. J Pain 2010;1112:1410–9.
    1. Jamison RN, Ross EL, Michna E, et al. Substance misuse treatment for high-risk chronic pain patients on opioid therapy: A randomized trial. Pain 2010;1503:390–400.
    1. Darnall BD, Scheman J, Davin S, et al. Pain psychology: A global needs assessment and national call to action. Pain Med 2016;172:250–63.
    1. Darnall BD, Sturgeon JA, Kao MC, Hah JM, Mackey SC.. From catastrophizing to recovery: A pilot study of a single-session treatment for pain catastrophizing. J Pain Res 2014;7:219–26.
    1. Darnall BD, Ziadni MS, Roy A, et al. Comparative efficacy and mechanisms of a single-session pain psychology class in chronic low back pain: Study protocol for a randomized controlled trial. Trials 2018;191:165–80.
    1. Sullivan MJ, Bishop SR, Pivik J.. The Pain Catastrophizing Scale: Development and validation. Psychol Assess 1995;74:524–32.
    1. Granot M, Ferber SG.. The roles of pain catastrophizing and anxiety in the prediction of postoperative pain intensity: A prospective study. Clin J Pain 2005;215:439–45.
    1. Hung M, Hon SD, Franklin JD, et al.. Psychometric properties of the PROMIS physical function item bank in patients with spinal disorders. Spine (Phila Pa 1976). 2014;39(2):158–63.
    1. Lai JS, Cella D, Choi S, et al. How item banks and their application can influence measurement practice in rehabilitation medicine: A PROMIS fatigue item bank example. Arch Phys Med Rehabil 2011;92(10 Suppl):S20–7.
    1. Revicki DA, Chen WH, Harnam N, et al. Development and psychometric analysis of the PROMIS pain behavior item bank. Pain 2009;146(1–2):158–69.
    1. Revicki DA, Cook KF, Amtmann D, Harnam N, Chen WH, Keefe FJ. Exploratory and confirmatory factor analysis of the PROMIS pain quality item bank. Qual Life Res. 2014;23(1):245–55.
    1. Hedrick TL, Harrigan AM, Thiele RH, et al. A pilot study of patient-centered outcome assessment using PROMIS for patients undergoing colorectal surgery. Support Care Cancer 2017;2510:3103–12.
    1. Morgan SJ, Friedly JL, Amtmann D, Salem R, Hafner BJ.. Cross-sectional assessment of factors related to pain intensity and pain interference in lower limb prosthesis users. Arch Phys Med Rehabil 2017;981:105–13.
    1. Farrar JT, Young JP Jr, LaMoreaux L, Werth JL, Poole RM.. Clinical importance of changes in chronic pain intensity measured on an 11-point numerical pain rating scale. Pain 2001;942:149–58.
    1. Carroll IR, Hah JM, Barelka PL, et al. Pain duration and resolution following surgery: An inception cohort study. Pain Med 2015;1612:2386–96.
    1. Hah J, Mackey SC, Schmidt P, et al. Effect of perioperative gabapentin on postoperative pain resolution and opioid cessation in a mixed surgical cohort: A randomized clinical trial. JAMA Surg 2018;1534:303–11.
    1. Olivier J, May WL, Bell ML.. Relative effect sizes for measures of risk. Commun Stat Theory Methods 2017;4614:6774–81.
    1. Azuero A. A note on the magnitude of hazard ratios. Cancer 2016;1228:1298–9.
    1. Ljungqvist O, Scott M, Fearon KC.. Enhanced recovery after surgery: A review. JAMA Surg 2017;1523:292–8.
    1. Reid DB, Shah KN, Ruddell JH, et al. Effect of narcotic prescription limiting legislation on opioid utilization following lumbar spine surgery. Spine J 2019;19(4):717–25.
    1. Geraghty AW, Torres LD, Leykin Y, Perez-Stable EJ, Munoz RF.. Understanding attrition from international Internet health interventions: A step towards global eHealth. Health Promot Int 2013;283:442–52.
    1. Eysenbach G. The law of attrition. J Med Internet Res 2005;71:e11..
    1. Coronado RA, George SZ, Devin CJ, Wegener ST, Archer KR.. Pain sensitivity and pain catastrophizing are associated with persistent pain and disability after lumbar spine surgery. Arch Phys Med Rehabil 2015;9610:1763–70.
    1. Khan RS, Ahmed K, Blakeway E, et al. Catastrophizing: A predictive factor for postoperative pain. Am J Surg 2011;2011:122–31.
    1. Papaioannou M, Skapinakis P, Damigos D, et al. The role of catastrophizing in the prediction of postoperative pain. Pain Med 2009;108:1452–9.
    1. Pavlin DJ, Sullivan MJ, Freund PR, Roesen K.. Catastrophizing: A risk factor for postsurgical pain. Clin J Pain 2005;211:83–90.
    1. Picavet HSJ, Vlaeyen JW, Schouten JS.. Pain catastrophizing and kinesiophobia: Predictors of chronic low back pain. Am J Epidemiol 2002;15611:1028–34.
    1. Riddle DL, Wade JB, Jiranek WA, Kong X.. Preoperative pain catastrophizing predicts pain outcome after knee arthroplasty. Clin Orthop Relat Res 2010;4683:798–806.
    1. Roh YH, Lee BK, Noh JH, et al. Effect of anxiety and catastrophic pain ideation on early recovery after surgery for distal radius fractures. J Hand Surg 2014;3911:2258–64.e2252.
    1. Ziehm S, Rosendahl J, Barth J, et al. Psychological interventions for acute pain after open heart surgery. Cochrane Database Syst Rev 2017;7:CD009984.
    1. Powell R, Scott NW, Manyande A, et al. Psychological preparation and postoperative outcomes for adults undergoing surgery under general anaesthesia. Cochrane Database Syst Rev 2016;5:CD008646.
    1. Yi JL, Porucznik CA, Gren LH, et al. The impact of preoperative mindfulness-based stress reduction on postoperative patient-reported pain, disability, quality of life, and prescription opioid use in lumbar spine degenerative disease: A pilot study. World Neurosurg 2019;121:e786–91.

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