Developing and Testing an Opioid Taper Intervention Before Total Knee Arthroplasty

全膝关节置换术前开发和测试阿片类药物逐渐减量干预

• 批准号: 10677778
• 负责人: Kevin Riggs
• 金额: $ 16.55万
• 依托单位: UNIVERSITY OF ALABAMA AT BIRMINGHAM
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-08-05 至 2026-07-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10677778
• 关键词: Adherence; Adopted; Analgesics; Award; Behavior; Caring; Characteristics; Chronic; Clinical; Clinical Pharmacists; Clinical Trials; Clinical Trials Design; Complication; Control Groups; Data; Degenerative polyarthritis; Dependence; Dose; Education; Educational Curriculum; Evaluation; Future; Goals; Health Services Research; Hyperalgesia; Instruction; Intervention; K-Series Research Career Programs; Knee; Knee Osteoarthritis; Literature; Measures; Mentored Patient-Oriented Research Career Development Award; Mentors; Mentorship; Methods; Operative Surgical Procedures; Opioid; Opioid Receptor; Outcome; Outcome Assessment; Outcome Measure; Pain; Pain management; Participant; Patient Outcomes Assessments; Patient-Focused Outcomes; Patients; Perioperative; Persons; Persuasive Communication; Pharmacists; Phase; Physicians; Pilot Projects; Positioning Attribute; Postoperative Pain; Postoperative Period; Preparation; Prospective Studies; Protocols documentation; Psychologist; Publishing; Quality of life; Randomized; Randomized, Controlled Trials; Recommendation; Rehabilitation therapy; Replacement Arthroplasty; Research; Research Personnel; Retrospective Studies; Telephone; Testing; Training; Uncertainty; Visit; behavior change; career; chronic pain; clinical trial implementation; education planning; efficacy testing; efficacy trial; experience; functional restoration; functional status; implementation outcomes; improved; improved outcome; knee replacement arthroplasty; motivational enhancement therapy; multidisciplinary; non-cancer chronic pain; operation; opioid tapering; opioid use; pain reduction; patient engagement; pilot trial; post-operative rehabilitation; programs; randomized trial; recruit; retention rate; secondary outcome; skills; smoking cessation; surgery outcome; therapy development

PROJECT SUMMARY Osteoarthritis of the knee is one of the most common causes of chronic pain in the US, and a common reason that patients take long-term opioids for pain. Total knee arthroplasty is often used to treat advanced knee osteoarthritis, with nearly a million patients undergoing total knee arthroplasty in the US each year. Many patients who undergo total knee arthroplasty are taking opioids preoperatively. However, preoperative opioid use is associated with worse postoperative pain, higher complication rates, and higher postoperative opioid use. Even low dose opioids can induce dependence and hyperalgesia, so postoperative pain can be harder to control in patients who have been taking chronic opioids, which can then lead to more difficult rehabilitation after surgery. Tapering opioids preoperatively holds potential to improve outcomes in total knee arthroplasty by counteracting these negative effects of opioids. However, the existing literature on preoperative opioid taper is limited. Several small retrospective studies have suggested a benefit, but detailed preoperative taper protocols have not been published, and high quality prospective studies have not been conducted. This proposal looks to advance the field of preoperative opioid tapering. Aim 1 will develop and refine a preoperative opioid taper protocol for patients undergoing total knee arthroplasty. Aim 2 will assess the feasibility of preoperative opioid taper intervention in a pilot randomized trial. At the completion of the pilot trial in Aim 2, the intervention will be ready to be tested for efficacy in a multicenter randomized control trial as the next step in this research. The overall goal of this 4-year Mentored Patient-Oriented Research Career Development Award (K23) proposal is to support Kevin Riggs, MD, MPH to become an independent investigator in the field of improving arthroplasty outcomes, with a focus on pain and opioid use. This award will provide comprehensive mentoring, training, and research experience to facilitate Dr. Riggs’s progression toward becoming an independent investigator. Specifically, Dr. Riggs will gain expertise in developing interventions, clinical trial design, and evaluation of functional status and other patient-reported outcome measures. This will position Dr. Riggs to become a leader in improving surgical outcomes for patients undergoing arthroplasty.

项目摘要 膝盖骨关节炎是美国慢性疼痛的最常见原因之一，这是一个常见的原因 患者服用长期阿片类药物治疗疼痛。总膝关节置换术通常用于治疗高级膝盖 骨关节炎，每年美国有近一百万患者接受总膝关节置换术。许多 术前接受阿片类药物的患者。但是，术前阿片类药物 使用与术后疼痛，较高的并发症发生率和较高的术后OOID有关 使用。即使是低剂量的阿片类药物也会诱导依赖性和痛觉过敏，因此术后疼痛可能更难 对服用慢性阿片类药物的患者的控制，这可能会导致更困难的康复 手术后。术前逐渐变细的阿片类药物具有通过 抵消阿片类药物的这些负面影响。但是，现有有关术前阿片类锥的文献是 有限的。一些小的回顾性研究提出了有益的，但详细的术前锥度方案 尚未发表，并且尚未进行高质量的前瞻性研究。该提议看 推进术前阿片类药物锥度的领域。 AIM 1将开发和完善术前阿片类药物锥度 接受总膝关节置换术的患者方案。 AIM 2将评估术前OID的可行性 试验随机试验中的锥度干预。在AIM 2进行试点试验时，干预将是 准备在多中心随机对照试验中测试效率，作为这项研究的下一步。这 这项为期4年的指导患者研究职业发展奖（K23）提案的总体目标是 为了支持凯文·里格斯（Kevin Riggs），医学博士，MPH，成为改善关节置换术领域的独立研究者 结果，重点是疼痛和阿片类药物。该奖项将提供全面的心理，培训和 研究经验是为了促进里格斯博士的发展，成为一名独立研究者。 特别是，里格斯博士将获得开发干预措施，临床试验设计和评估的专业知识 功能状态和其他患者报告的结果指标。这将使里格斯博士成为领导者 在改善接受促交关系统置换术的患者的手术结局中。

项目成果

ASA Physical Status Determination by General Internists and Impact on Cardiac Risk Assessment.

普通内科医生的 ASA 身体状况测定及其对心脏风险评估的影响。

• DOI: 10.14423/smj.0000000000001579
• 发表时间: 2023
• 期刊: Southern medical journal
• 影响因子: 1.1
• 作者: Riggs,KevinR;Shaneyfelt,Terrance;Cherrington,AndreaL;Simmons,JeffreyW;Hage,FadiG;Morris,MelanieS;Kertesz,StefanG;Richman,JoshuaS
• 通讯作者: Richman,JoshuaS