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.

项目摘要/摘要 阿片类药物的流行刺激了紧急和广泛的法律、医疗和行为方法，以促进 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年)。负责任的阿片类药物处方依赖于对滥用的准确和早期识别 以及全面了解疼痛治疗寻求和成功疼痛的预测因素 管理学(Dowell，Haegerich，&Chou，2016)。一个有前景且实用的疼痛管理解决方案是 远程自我监控，这是一种先进的评估工具，被证明优于回溯性评估 (如Heron&Smyth，2010)。不幸的是，低依从率阻碍了远程自我保护的使用 对慢性疼痛患者的监测(例如，Jamison等人，2016)，即使在非金钱奖励是 包括(Jamison等人，2017年)。提高遵从性的一个强有力的策略是应急管理 (厘米)。虽然中医药已被广泛应用于研究，但由于以下原因，转化为临床实践一直受到限制 实际障碍(例如，成本)和辅导员的担忧。 这一阶段1行为疗法开发赠款(Rounaville等人，2001)试图对一种新的、完全的 自动化CM APP(DynamiCare Rewards)，用于促进对疼痛症状严重性和 相关变量(如睡眠、情绪)以及Rx阿片类药物、酒精和Rx的数量和频率 苯二氮类药物在慢性疼痛患者样本中的使用目前开出了阿片类药物。我们计划定制 在研究的前3个月，DynamiCare奖励应用程序用于初级保健中的慢性疼痛。在 18个月后，将进行一项试验性随机对照试验(N=80)，比较接受CM的参与者是否完成 每日自我监测调查(CM组)和那些只收到电子每日提醒完成 为期30天的调查(对照组)。主要结果衡量标准包括每日调查次数 已完成且持续坚持完成调查的时间最长。我们假设那些在 CM组将完成更多的日常自我监测调查，并拥有更长的日常调查持续时间 完成率与控制组的比较。其次，我们将检查Rx的可行性、可接受性和准确性 阿片类药物、酒精和Rx苯二氮类药物使用报告。 本论文的建议将为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、相关因素和处方阿片类药物的使用。关于疼痛的更全面的信息 经验和处方阿片类药物的使用有可能帮助临床医生提供更好的护理和制造更好的阿片类药物 开出决定的处方。此外，这些发现将为未来关于早期识别、预防和治疗的研究提供信息 阿片类药物使用障碍的干预。

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.