Background and Significance
Studies suggest that long-term opioid use for chronic pain does not help reduce pain or help patients live fuller lives. Opioid medications have major health risks, even when taken exactly as prescribed, including worsening pain. There are no studies that tell prescribers how to best address their patients’ concerns and engage them in opioid reduction, and how to best help them achieve meaningful and successful outcomes that last long term. Our patients told us that for opioid reduction to be successful, the benefit of lower dosage needs to be well understood by them. Further, the patients want to work with their doctors to create such an opioid reduction treatment plan. Based on this input, we developed a patient-centered study that encourages patient interest and willingness to actively and collaboratively reduce opioid use and test two well-established behavioral intervention pain treatments.
We will test which of two types of pain management classes is best for reducing pain and pain interference, increasing function, and reducing opioid use within the context of active, collaborative, patient-centered opioid reduction that addresses their main concerns.
We will study the effectiveness of two types of active behavioral pain management treatment classes in patients prescribed long-term opioids from primary care and pain clinics in four states in the western United States. Patients who wish to reduce opioid use will collaborate with their doctor to co-create a tailored plan to reduce their use of opioids. Recognizing that some patients are not ready to reduce opioid use, we will also enroll patients who decided not to increase their opioid dose during the one-year study period (opioid dose containment group). All study patients will be assigned to either eight-week group cognitive behavioral therapy for chronic pain, a six-week peer-led chronic pain self-management program, or no behavioral treatment. Our two active behavioral treatment options are evidence based and widely available. We will determine which behavioral treatment works best and for whom for pain control, functioning, and opioid use reduction at 12 months within the context of collaborative opioid reduction. We will determine whether the behavioral treatments help improve readiness to reduce opioid use for those who elected to hold their opioid dose constant. Our study outcomes were informed by our patient stakeholders and include pain intensity, opioid use, pain interference, role function, anxiety, depression, pain catastrophizing, sleep, fatigue, and medication side effects. Patients with any type of chronic pain may enroll, except for patients with active addiction or behavioral or safety concerns. Our project focuses on community outpatient settings, where most U.S. patients receive prescribed opioids. Our project is designed so that the results can be broadly applied to anywhere in the United States.
*All proposed projects, including requested budgets and project periods, are approved subject to a programmatic and budget review by PCORI staff and the negotiation of a formal award contract.