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.

项目总结/摘要 阿片类药物的流行促使人们采取紧急和广泛的法律的、医学和行为方法来促进 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早期识别滥用 以及对疼痛治疗寻求和成功疼痛的预测因素的全面理解 管理（Dowell，Haegerich，& Chou，2016）。一个有前途和实用的疼痛管理解决方案是 远程自我监测，一种最先进的评估工具，上级回顾性评估 (e.g., Heron & Smyth，2010）。不幸的是，低的遵守率阻碍了远程自我管理的使用。 在慢性疼痛患者中进行监测（例如，Jamison等人，2016年，即使非货币奖励 包括（Jamison等人，2017年）。提高依从性的一个强有力的策略是应急管理 （CM）。虽然CM已被广泛用于研究，但由于以下原因，将其转化为临床实践一直是有限的： 实际障碍（例如，费用）和顾问的关注。 该第1阶段行为疗法开发资助（Rounsaville等人，2001年）试图试点测试一部小说，完全 自动化CM应用程序（DynamiCare Rewards），用于促进疼痛症状严重程度的日常自我监测， 相关变量（例如，睡眠、情绪），以及Rx阿片类药物、酒精和Rx的量和频率 目前处方阿片类药物的慢性疼痛患者样本中苯二氮卓类药物的使用。我们计划定制 在研究的前3个月，DynamiCare Rewards应用程序用于初级保健中的慢性疼痛。在 18个月后，将进行一项试点RCT（N=80），比较接受CM的参与者完成 每日自我监测调查（CM组）和那些只收到电子每日提醒，以完成 调查（对照组）30天。主要成果指标包括每日调查次数 已完成且持续遵守调查完成的最长时间。我们假设， CM组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 与对照组相比，其次，我们将检查处方的可行性、可接受性和准确性 阿片类药物、酒精和Rx苯二氮卓类药物使用报告。 本论文的建议将提供基准数据的有效性和可行性的CM，以促进自我， 监测疼痛严重程度、相关因素和Rx阿片类药物使用。关于疼痛的更多信息 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， 处方决定。此外，研究结果将为未来的早期识别，预防和治疗研究提供信息。 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.