"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
"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
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DOI：
10.1093/pm/pnz094
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发表时间：
2019-11-01
期刊：
影响因子：
3.1
通讯作者：
Wheeler, Amanda
中科院分区：
文献类型：
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作者：
Darnall, Beth D.;Ziadni, Maisa S.;Wheeler, Amanda
Objective.本研究旨在评估数字化围手术期行为疼痛医学干预在乳腺癌手术中的可行性，并评估其对术后疼痛灾难化、疼痛和阿片类药物停用的影响。设计和设置。在斯坦福大学（Palo Alto，CA，USA）进行了一项随机对照临床试验，比较了数字行为疼痛医学干预（“My Surgical Success”[MSS]）与数字一般健康教育（HE）。参与者127名参与者的便利样本被随机分配到治疗组。分析样本为68例患者（N = 36例MSS，N = 32例HE）。主要成果。主要结果是数字行为疼痛医学干预的可行性和可接受性（可接受性项目的80%阈值）。次要结局是疼痛灾难化，过去七天的平均疼痛强度，以及开始使用阿片类药物的患者手术后阿片类药物停止使用的时间。结果MSS干预的损耗率（44%）明显高于HE对照（18%），但低于电子健康干预的典型损耗率（60-80%）。尽管MSS的磨损更大，但56%的MSS患者证明了可行性，并且达到了80%的可接受性阈值。我们观察到基线疼痛灾难化的地板效应，术后疼痛灾难化或疼痛强度没有显著的组间差异。与HE对照组相比，MSS与12周研究期间阿片类药物停用几率增加86%相关（风险比= 1.86，95%置信区间= 1.12-3.10，P = 0.016）。结论.分配到MSS的患者中有五十六%参与了在线平台，并报告了很高的满意度。MSS与手术后阿片类药物停用显著加速相关（5天差异），与对照组相比，疼痛报告无差异。围手术期数字行为疼痛药物可能是一种低成本，可获得的辅助药物，可以促进乳腺癌手术后阿片类药物的停用。
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 post-surgical 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.