Nonpharmacological Strategies to Mitigate Pain and Problematic Opioid Use After Spine Surgery

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PROJECT SUMMARY/ABSTRACT Background: Pain and problematic opioid use is common in the months following spine surgery. The goal for Dr. John Magel's NCATS/NCCIH KL2 Administrative Supplemental Award is to acquire the necessary training, practical experience, and knowledge to be a leading independent investigator who focuses on rehabilitation to improve outcomes and mitigate problematic prescription opioid use (PPOU) in patients with chronic musculoskeletal conditions. His proposed career development award is designed to support this transition. He will use prospective and qualitative methodologies to determine the extent to which maladaptive beliefs (pain- catastrophizing, kinesiophobia, and pain self-efficacy) measured after spine surgery impacts opioid use and whether opportunities exist to tailor rehabilitation toward improving pain and reducing opioid consumption in patients at risk for PPOU. Research Design and Methods: A prospective cohort of patients who had spine surgery will be used to determine associations between maladaptive pain beliefs and the outcomes of future opioid use and physical function in patients at risk PPOU. In a separate cohort of patients who had spine surgery, semi-structured interviews will be used to evaluate the perceptions of patients related to post-surgical nonpharmacologic interventions performed by physical therapists. Aim 1: In patients at risk for PPOU, determine the impact of maladaptive pain beliefs measured after spinal surgery on opioid use and physical functioning. Opioid use and physical function during the 3-6 month postoperative period in patients after spine surgery who are at risk for PPOU will be evaluated. The association between maladaptive pain beliefs (pain catastrophizing, kinesiophobia, and pain self-efficacy) on (1a) opioid use and (1b) physical function while controlling for covariates (e.g., attendance in PT, patient demographics, comorbidities, surgical type) will be assessed. Aim 2: Determine the perceptions of nonpharmacologic postoperative pain management strategies in patients using prescription opioids after spine surgery. Semi-structured, in-depth interviews will be used to identify themes among the patients that describe their perceptions of nonpharmacologic postoperative pain management. Career Development Plan: The KL2 Career Development Award with address these gaps in my current research abilities: 1) develop expertise in opioid risk assessment and risk mitigation, 2) develop skills in designing and conducting clinical trials and in and qualitative and mixed methods for health systems research 3) cultivate skills to independently lead and manage a research program. These weaknesses will be addressed using the resources the resources provided by the university of Utah's robust KL2 program and through recommended courses and hands-on training as well as interacting with an international recognized team of expert mentors and advisors.