Efficacy of motivational-interviewing and guided opioid tapering support for patients undergoing orthopedic surgery (MI-Opioid Taper): A prospective, assessor-blind, randomized controlled pilot trial
| Autor: | Yasamin Sharifzadeh, Stuart B. Goodman, Balasubramanian Narasimhan, Jodie A. Trafton, Ian Carroll, Heather Hilmoe, Sean Mackey, Partha Krishnamurthy, Jennifer M. Hah, James I. Huddleston, William J. Maloney, Derek F. Amanatullah |
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| Rok vydání: | 2020 |
| Předmět: |
medicine.medical_specialty
Randomization medicine.medical_treatment Motivational interviewing Pain cessation Chronic opioid use after surgery 01 natural sciences Surgical recovery law.invention 03 medical and health sciences 0302 clinical medicine Randomized controlled trial law medicine 030212 general & internal medicine Opioid cessation 0101 mathematics Adverse effect Opioid tapering lcsh:R5-920 Persistent postoperative opioid use business.industry pilot study 010102 general mathematics Orthopedic General Medicine medicine.disease Arthroplasty Substance abuse Opioid tapering support Opioid Total knee arthroplasty Orthopedic surgery Physical therapy Surgery Total hip arthroplasty Randomized trial lcsh:Medicine (General) business Research Paper medicine.drug |
| Zdroj: | EClinicalMedicine, Vol 28, Iss, Pp 100596-(2020) EClinicalMedicine |
| ISSN: | 2589-5370 |
| DOI: | 10.1016/j.eclinm.2020.100596 |
| Popis: | Background Postoperative opioid use can lead to chronic use and misuse. Few studies have examined effective approaches to taper postoperative opioid use while maintaining adequate analgesia. Methods This randomized, assessor-blinded, pilot trial of postoperative motivational interviewing and guided opioid tapering support (MI-Opioid Taper) added to usual care (UC) enrolled patients undergoing total hip or knee arthroplasty at a single U.S. academic medical center. MI-Opioid Taper involved weekly (to seven weeks) and monthly (to one year) phone calls until patient-reported opioid cessation. Opioid tapering involved 25% weekly dose reductions. The primary feasibility outcome was study completion in the group to which participants were randomized. The primary efficacy outcome, time to baseline opioid use, was the first of five consecutive days of return to baseline preoperative dose. Intention-to-treat analysis with Cox proportional hazards regression was adjusted for operation. ClinicalTrials.gov registration: NCT02070003. Findings From November 26, 2014, to April 27, 2018, 209 patients were screened, and 104 patients were assigned to receive MI-Opioid Taper (49 patients) or UC only (55 patients). Study completion after randomization was similar between groups (96.4%, 53 patients receiving UC, 91.8%, 45 patients receiving MI-Opioid Taper). Patients receiving MI-Opioid Taper had a 62% increase in the rate of return to baseline opioid use after surgery (HR 1.62; 95%CI 1.06–2.46; p = 0•03). No trial-related adverse events occurred. Interpretation In patients undergoing total joint arthroplasty, MI-Opioid Taper is feasible and future research is needed to establish the efficacy of MI-Opioid Taper to promote postoperative opioid cessation. Funding National Institute on Drug Abuse |
| Databáze: | OpenAIRE |
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