Psychological Factors Contributing to Persistent Opioid Use After Surgery

描述（由申请人提供）：本指导患者导向研究职业发展奖（K23）将支持Jennifer Hah博士在临床研究方面的研究和培训，以了解心理因素，持续使用阿片类药物和手术后疼痛之间的关系。每年有4500万美国人接受手术，导致急性疼痛和处方阿片类药物的使用；医源性阿片类药物暴露是处方阿片类药物成瘾的重要诱因。哈博士拥有麻醉学、疼痛医学和流行病学的背景。她将在疼痛、心理学和成瘾研究方面接受进一步的培训。我们之前的研究已经确定术前抑郁症状升高是手术后延迟阿片类药物停止的预测因子。阿片类药物剂量达到峰值时的短暂情绪稳定可能使已有情绪困扰的患者持续使用阿片类药物。关于情绪如何通过手术和康复与疼痛和阿片类药物使用相关，存在一个关键的知识缺口。本提案的第一个研究目的是表征情绪困扰，阿片类药物使用和手术和恢复过程中疼痛变化之间的关系。将获得情绪困扰、影响、阿片类药物使用、阿片类药物滥用和疼痛的基线和纵向评估。哈博士将使用美国国立卫生研究院患者报告结果测量信息系统（PROMIS）的情绪困扰信息库和计算机化的适应性测试作为纵向数据收集的一部分。使用NIH PROMIS将有助于捕捉情绪困扰的实时变化，因为它与阿片类药物的使用和疼痛有关，以一种从未在手术后完成的方式。第二个研究目的是比较动机性访谈和医生指导的阿片类药物断奶与手术后的常规护理，以减少阿片类药物的持续使用。这一简短的心理干预将通过试图防止术后持续使用阿片类药物来解决处方阿片类药物滥用的流行。目前标准的阿片类药物处方以及在疼痛缓解后停止使用阿片类药物的指示不足以解决阿片类药物持续使用、误用和滥用的风险。我们提出了一种新的心理干预，其中包括医生指导的阿片类药物断奶方案，每7天服用阿片类药物总剂量的25%。患者将同时监测疼痛增加和阿片类药物戒断症状。我们的研究可能会导致临床实践的重大转变，在恢复过程中更多地关注适当的阿片类药物管理。此外，没有研究检查最佳阿片类药物管理和减少策略的患者从手术恢复。总的来说，拟议的研究将推进关于心理因素在延迟阿片类药物术后停止中的作用的知识。根据拟议的研究结果，Dr. Hah计划申请独立资金，开发非药物干预措施，以减少术后持续使用和滥用阿片类药物的心理风险因素。

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.