Connected Health to Decrease Opioid Use in Patients With Chronic Pain

University of Pennsylvania

Status: Completed

Conditions: Chronic Pain

Treatments: Behavioral: Way to Health technology enhanced care; Behavioral: Regret lottery

Study type: Interventional

Funder types: Other

Identifiers

NCT04013529

01758

Details and patient eligibility

About

The objective of this pilot study to evaluate if behavioral incentives applied at the VA Medical Center can appreciably increase participation in activities that promote mobility, and subsequently reduce pain severity and opioid use.

Full description

Chronic pain is a highly prevalent and costly condition in the US. An estimated 88.5 million adults suffer from daily pain, resulting in estimated cost of $500- 635 biJlion due to lost productivity, and $261-300 billion in health care expenditures. To manage their chronic pain, 5 to 8 million Americans take an opioid medication daily. Yet , the risks associated with ongoing opioid prescription , including overdose, abuse and diversion, temper their analgesic effects.

Opioids are not more effective in the treatment of chronic pain compared with non-opioid approaches. Current guidelines have adapted to the evidence, recommending opioid-sparing approaches for treating patients with chronic pain, and tapering for those on higher doses to safer levels of use. Tapering opioids, however, requires replacing them with effective non-opioid strategies. Improving mobility has been shown to improve pain and decrease medication use among patients chronically prescribed opiates. Concurrently, financial incentives and the use of behavioral incentives have been shown to promote mobility.

Appreciating the gains in health outcomes that can be made with "connected health" approaches, we propose a novel pilot study designed to evaluate if technology enabled care (TEC) strategies and financial incentives can improve patient mobility in our chronic pain population, reduce pain and decrease opioid use . Our primary aim is to determine if chronic pain patients who receive TEC-enhanced treatment with financial incentives demonstrate increased participation in activities that promote mobility (physical therapy, yoga, tai chi) in comparison to patients receiving usual care. Secondary outcomes will include whether increased activity participation also reduces pain severity and opioid use, and improves function and increases the number of daily steps taken. The results of this pilot will enable us to determine what strategies are effective at increasing mobility and if these gains translate into reduced pain and decreased opioid use.

Enrollment: 40 patients

Sex: All

Ages: 18 to 70 years old

Volunteers: No Healthy Volunteers

Inclusion criteria

• Chronic non-malignant pain
• High dose opioid therapy
• Possession of activated cell phone with text messaging capabilities
• Willingness to comply with study requirements

Exclusion criteria

• Pain of malignant origin
• Sensory impairments precluding use of text messaging and activity tracker
• Physical disability precluding improvements in physical activity

Trial design

Primary purpose: Treatment

Allocation: Randomized

Interventional model: Parallel Assignment

Masking: Single Blind

---

40 participants in 2 patient groups, including a placebo group

Control

Placebo Comparator group

Description:

Participate in technology-enabled care without regret lottery

Treatment:

Behavioral: Way to Health technology enhanced care

Experimental

Experimental group

Description:

Participate in technology-enabled care with regret lottery

Treatment:

Behavioral: Regret lottery

Behavioral: Way to Health technology enhanced care