Using mobile-based contingency management to promote daily self-monitoring of pain severity and prescription opioid use in a primary care sample of chronic pain patients.

使用基于移动设备的应急管理来促进慢性疼痛患者初级保健样本中疼痛严重程度和处方阿片类药物使用的日常自我监测。

• 批准号: 9926478
• 负责人: Kathryn McKenzie Polak
• 金额: $ 0.85万
• 依托单位: VIRGINIA COMMONWEALTH UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2018
• 资助国家: 美国
• 起止时间: 2018-09-30 至 2020-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9926478
• 关键词: Adherence; Agreement; Alcohols; Assessment tool; Behavior; Behavior Therapy; Behavioral; Benchmarking; Benzodiazepines; Caring; Cellular Phone; Centers for Disease Control and Prevention (U.S.); Control Groups; Custom; Data; Decision Making; Early identification; Frequencies; Funding; Goals; Grant; Hour; Incentives; Instruction; Legal; Measures; Medical; Methods; Monitor; Moods; Opioid; Outcome Measure; Pain; Pain management; Participant; Patient Self-Report; Performance; Phase; Preparation; Preventive Intervention; Primary Health Care; Principal Investigator; Procedures; Professional counselor; Psychological reinforcement; Public Health; Randomized; Reporting; Research; Research Personnel; Resistance; Rewards; Sampling; Scientist; Severities; Sleep; Surveys; Testing; Time; Translations; United States National Institutes of Health; Visit; Vulnerable Populations; Work; addiction; adherence rate; base; chronic pain; chronic pain patient; clinical practice; clinically relevant; contingency management; cost; experience; experimental group; follow up assessment; follow-up; improved; innovation; member; misuse of prescription only drugs; novel; opioid epidemic; opioid misuse; opioid use; opioid use disorder; pain symptom; prescription opioid; primary outcome; psychologic; smartphone Application; therapy development; training opportunity

Project Summary/Abstract The opioid epidemic has spurred urgent and widespread legal, medical, and behavioral approaches to promote effective opioid prescribing. Between 21-29% of chronic pain patients misuse prescription (Rx) opioids (Vowles et al., 2015). Responsible opioid prescribing depends on accurate and early identification of misuse as well as comprehensive understanding of predictors of pain treatment seeking and successful pain management (Dowell, Haegerich, & Chou, 2016). One promising and practical pain management solution is remote self-monitoring, a state-of-the-art assessment tool shown to be superior to retrospective assessment (e.g., Heron & Smyth, 2010). Unfortunately, low rates of adherence have impeded the use of remote self- monitoring among chronic pain patients (e.g., Jamison et al., 2016), even when non-monetary rewards were included (Jamison et al., 2017). One robust strategy for improving adherence is contingency management (CM). While CM has been widely used in research, translation to clinical practice has been limited, due to practical barriers (e.g., costs) and counselor concerns. This Stage 1 behavioral therapies development grant (Rounsaville et al., 2001) seeks to pilot test a novel, fully automated CM app (DynamiCare Rewards) for promoting daily self-monitoring of pain symptom severity and related variables (e.g., sleep, mood), as well as quantity and frequency of Rx opioid, alcohol, and Rx benzodiazepine use in a sample of chronic pain patients currently prescribed opioids. We plan to customize the DynamiCare Rewards app for chronic pain in primary care in the first 3 months of the study. In the following 18 months, a pilot RCT (N=80) will be conducted comparing participants receiving CM for completing daily self-monitoring surveys (CM group) and those receiving only electronic daily reminders to complete the survey (control group) over a 30-day period. Primary outcome measures include number of daily surveys completed and longest period of sustained adherence to survey completion. We hypothesize that those in the CM group will complete more daily self-monitoring surveys and have a longer sustained period of daily survey completion compared to controls. Secondarily, we will examine feasibility; acceptability; and accuracy of Rx opioid, alcohol, and Rx benzodiazepine use reporting. This dissertation proposal will provide benchmark data on the efficacy and feasibility of CM to promote self- monitoring of pain severity, related factors, and Rx opioid use. More comprehensive information about pain experience and Rx opioid use has the potential to help clinicians provide better care and make better opioid prescribing decisions. Additionally, findings will inform future research on early identification, prevention, and intervention for Opioid Use Disorders.

项目概要/摘要 阿片类药物的流行催生了紧急而广泛的法律、医疗和行为方法来促进 有效的阿片类药物处方。 21-29% 的慢性疼痛患者滥用处方 (Rx) 阿片类药物 （Vowles 等人，2015）。负责任的阿片类药物处方取决于准确和及早识别滥用情况 以及对疼痛治疗寻求和成功疼痛的预测因素的全面了解 管理（Dowell、Haegerich 和 Chou，2016）。一种有前途且实用的疼痛管理解决方案是 远程自我监控，一种先进的评估工具，优于回顾性评估 （例如，Heron 和 Smyth，2010）。不幸的是，遵守率低阻碍了远程自助的使用 对慢性疼痛患者进行监测（例如，Jamison 等，2016），即使非金钱奖励 包括（Jamison 等人，2017）。提高依从性的一项强有力的策略是应急管理 （厘米）。虽然 CM 已广泛应用于研究，但由于以下原因，其转化为临床实践的能力受到限制： 实际障碍（例如费用）和辅导员的担忧。 第一阶段行为疗法开发补助金（Rounsaville 等人，2001 年）旨在试点测试一种新颖的、全面的行为疗法。 自动化 CM 应用程序（DynamiCare Rewards），用于促进日常自我监测疼痛症状的严重程度和 相关变量（例如睡眠、情绪），以及处方阿片类药物、酒精和处方的数量和频率 目前服用阿片类药物的慢性疼痛患者样本中使用苯二氮卓类药物的情况。我们计划定制 DynamiCare Rewards 应用程序用于研究前 3 个月初级保健中的慢性疼痛。在 18 个月后，将进行试点随机对照试验 (N=80)，比较接受 CM 的参与者完成 每日自我监测调查（CM 组）和仅接受每日电子提醒以完成调查的人 为期 30 天的调查（对照组）。主要结果指标包括每日调查的数量 已完成以及持续坚持调查完成的最长期限。我们假设那些在 招商局集团将完成更多的日常自我监测调查，并有更长的持续时间的日常调查 与对照相比完成情况。其次，我们会考察可行性；可接受性；和 Rx 的准确性 阿片类药物、酒精和 Rx 苯二氮卓类药物的使用报告。 本论文提案将为 CM 促进自我发展的有效性和可行性提供基准数据。 监测疼痛严重程度、相关因素和 Rx 阿片类药物的使用。有关疼痛的更全面的信息 经验和 Rx 阿片类药物的使用有可能帮助临床医生提供更好的护理并制造更好的阿片类药物 规定决策。此外，研究结果将为未来的早期识别、预防和预防研究提供信息。 对阿片类药物使用障碍的干预。

项目成果

Screening for substance use in pregnancy and the newborn.

筛查妊娠期和新生儿的物质使用情况。

• DOI: 10.1016/j.siny.2019.01.007
• 发表时间: 2019
• 期刊: Seminars in fetal & neonatal medicine
• 影响因子: 3
• 作者: Polak,Kathryn;Kelpin,Sydney;Terplan,Mishka
• 通讯作者: Terplan,Mishka