Psychological Factors Contributing to Persistent Opioid Use After Surgery

该指导以患者为导向的研究职业发展奖（K23）将支持Jennifer Hah博士在临床研究中的研究和培训，这些研究与了解心理因素，持续使用阿片类药物和手术后疼痛之间的关系有关。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。Hah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获得进一步的培训。我们以前的研究已经确定，术前抑郁症状升高是手术后延迟阿片类药物停用的预测因素。阿片类药物峰值剂量下的短暂情绪稳定可能会使先前存在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恢复与疼痛和阿片类药物使用相关，存在着关键的知识差距。该提案的第一个研究目标是描述整个手术和恢复过程中情绪困扰，阿片类药物使用和疼痛变化之间的关系。将获得情绪困扰、情感、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。Hah博士将使用NIH患者报告结局测量信息系统（PROMIS）项目库进行情绪困扰和计算机化自适应测试，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，这在手术后从未实现过。第二个研究目的是比较动机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。这种简短的心理干预将通过试图防止手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。目前的标准阿片类药物处方加上疼痛缓解后停止使用阿片类药物的说明不足以解决持续使用阿片类药物、误用和滥用的风险。我们提出了一种新的心理干预措施，其中包括医生指导的阿片类药物戒断方案，每7天戒断25%的阿片类药物总剂量。将同时监测患者的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，使人们更加关注恢复期间的适当阿片类药物管理。此外，还没有研究探讨手术后恢复患者的最佳阿片类药物管理和减量策略。总的来说，拟议的研究将推进有关心理因素在延迟手术后阿片类药物停用中的作用的知识。根据拟议研究的结果，Hah博士计划申请独立资金来开发非药物干预措施，以减少手术后持续使用阿片类药物和滥用的心理风险因素。

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.