Psychological Factors Contributing to Persistent Opioid Use After Surgery

导致手术后持续使用阿片类药物的心理因素

• 批准号: 8487036
• 负责人: Jennifer Hah
• 金额: $ 18.06万
• 依托单位: STANFORD UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2013
• 资助国家: 美国
• 起止时间: 2013-04-15 至 2018-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8487036
• 关键词: Acute Pain; Address; Adherence; Adverse event; Affect; Affective; American; Anesthesiology; Anger; Anxiety; Area; Attention; Award; Beck depression inventory; Chronic; Clinical Research; Cognitive; Coupled; Data; Data Collection; Dose; Drug abuse; Drug usage; Emotions; Environmental Risk Factor; Epidemic; Epidemiology; Feasibility Studies; Funding; Future; Goals; Individual; Information Systems; Instruction; Intervention; K-Series Research Career Programs; Knowledge; Measurement; Measures; Medicine; Mental Depression; Mental Health; Mentored Patient-Oriented Research Career Development Award; Monitor; Moods; National Institute of Drug Abuse; Operative Surgical Procedures; Opiate Addiction; Opioid; Pain; Pain management; Participant; Patient Outcomes Assessments; Patients; Physicians; Pilot Projects; Postoperative Pain; Protocols documentation; Psychological Factors; Psychology; Psychometrics; Public Health; Randomized; Randomized Controlled Trials; Recovery; Reporting; Research; Research Personnel; Research Training; Resolution; Risk; Risk Factors; Role; Substance abuse problem; Testing; Therapeutic Intervention; Time; Total Hip Replacement; Training; Treatment Efficacy; United States National Institutes of Health; Variant; Weaning; Withdrawal Symptom; addiction; base; chronic pain; clinical practice; cohort; computerized; depressive symptoms; effective intervention; emotional distress; follow-up; high risk; improved; instrument; knee replacement arthroplasty; minimally invasive; motivational enhancement therapy; novel; opioid misuse; opioid withdrawal; optimism; patient oriented; prescription opioid; prescription opioid abuse; prevent; prospective; psychologic; public health relevance; treatment as usual

DESCRIPTION (provided by applicant): This Mentored Patient-Oriented Research Career Development Award (K23) will support Dr. Jennifer Hah¿s research and training in clinical research related to understanding the relationship between psychological factors, persistent opioid use, and pain after surgery. Forty-five million Americans undergo surgery every year with resulting acute pain and prescription opioid use; and iatrogenic opioid exposure is an important instigator of prescription opioid addiction. Dr. Hah has a background in anesthesiology, pain medicine, and epidemiology. She will gain further training in aspects of pain, psychology, and addiction research. Our previous research has identified pre-operative elevated depressive symptoms as a predictor of delayed opioid cessation after surgery. Transient mood stabilization at peak opioid doses may perpetuate opioid use in patients with pre-existing emotional distress. A critical knowledge gap exists regarding how mood relates to pain and opioid use through surgery and recovery. The first research aim of this proposal is to characterize the relationship between changes in emotional distress, opioid use, and pain throughout surgery and recovery. Baseline and longitudinal assessments of emotional distress, affect, opioid use, opioid misuse, and pain will be obtained. Dr. Hah will use the NIH Patient-Reported Outcomes Measurement Information System (PROMIS) item banks for emotional distress and computerized adaptive testing as part of longitudinal data collection. Use of the NIH PROMIS will facilitate capturing real-time changes in emotional distress, as it relates to opioid use and pain, in a way that has never been accomplished after surgery. The second research aim is to compare motivational interviewing and physician-guided opioid weaning vs. usual care after surgery to reduce persistent opioid use. This brief psychological intervention will address the epidemic of prescription opioid abuse by attempting to prevent the occurrence of persistent opioid use after surgery. The current standard opioid prescription coupled with instructions to cease opioid use upon pain resolution is inadequate to address the risks of persistent opioid use, misuse, and abuse. We propose a novel psychological intervention, which includes a physician-guided opioid weaning protocol of 25% of the total opioid dose every seven days. Patients will be concurrently monitored for increasing pain and opioid withdrawal symptoms. Our research may result in a major shift in clinical practice drawing more attention to proper opioid management during recovery. Furthermore, no studies have examined optimal opioid management and tapering strategies for patients recovering from surgery. Overall, the proposed research will advance knowledge regarding the role of psychological factors in delaying opioid cessation after surgery. Based on the results of the proposed research, Dr. Hah plans to apply for independent funding to develop non-pharmacologic interventions to decrease psychological risk factors of persistent opioid use and misuse after surgery.

描述（由适用提供）：这一受过指导的面向患者的研究职业发展奖（K23）将支持詹妮弗·哈赫博士的研究和培训临床研究的研究和培训，与了解心理因素，持续的阿片类药物使用和手术后疼痛之间的关系有关。每年有400万美国人接受手术，导致急性疼痛和处方阿片类药物使用；医源性阿片类药物暴露是处方阿片类成瘾的重要煽动者。 HAH博士在麻醉，疼痛医学和流行病学方面具有背景。她将在疼痛，心理学和成瘾研究方面进行进一步的培训。我们以前的研究已经确定了手术较高的抑郁症状是手术后阿片类药物停止延迟的预测指标。阿片类药物峰值处的瞬时情绪稳定可能会使患有情绪困扰的患者的阿片类药物使用。关于情绪通过手术和康复与疼痛和阿片类药物使用相关的关键知识差距存在。该提案的第一个研究目的是表征情绪困扰，阿片类药物使用以及整个手术和康复疼痛的关系之间的关系。将获得对情绪困扰，情感，阿片类药物使用，阿片类药物的小姐和疼痛的基线和纵向评估。 HAH博士将使用NIH患者报告的结果测量信息系统（Promis）项目库进行情绪困扰和计算机化自适应测试作为纵向数据收集的一部分。 NIH Promis的使用将促进与阿片类药物使用和疼痛有关的情绪困扰的实时变化，而手术后从未完成过。第二个研究的目的是比较动机访谈和物理引导的阿片类药物断奶与手术后通常的护理，以减少持续的阿片类药物使用。这种简短的心理干预将通过试图防止手术后持续使用OID的发生来解决处方阿片类药物滥用的流行。当前的标准OOID处方加上指示以解决疼痛时停止使用的说明不足以解决持续使用，滥用和滥用的风险。我们提出了一种新颖的心理干预措施，其中包括每七天总OID剂量的25％的物理引导的Ooid断奶方案。将同时监测患者，以增加疼痛和OID戒断症状。我们的研究可能导致临床实践的重大转变引起人们对恢复过程中适当的阿片类药物管理的更多关注。此外，尚无研究检查从手术中恢复的患者的最佳阿片类药物管理和逐渐变细的策略。总体而言，拟议的研究将提高有关心理因素在延迟手术后停止暂停的知识。根据拟议的研究的结果，HAH博士计划申请独立的资金，以开发非药物干预措施，以减少持续的阿片类药物使用和手术后的心理危险因素。