A digital health intervention to support patients with chronic pain during prescription opioid tapering: a pilot randomised controlled trial

Introduction

Recent changes in opioid prescribing guidelines have led to an increasing number of patients with chronic pain being recommended to taper. However, opioid tapering can be challenging, and many patients require support.

Objectives

We evaluated the feasibility, acceptability, and potential efficacy of a codesigned digital health intervention to support patients with chronic pain during voluntary prescription opioid tapering.

Methods

In a pilot randomised controlled trial, participants received a psychoeducational video and 28 days of text messages (2 SMS/day) in addition to their usual care (intervention) or usual care alone (control). The feasibility, acceptability, and potential efficacy of the intervention were evaluated. The primary outcome was opioid tapering self-efficacy. Secondary outcomes were pain intensity and interference, anxiety and depression symptom severity, pain catastrophising, and pain self-efficacy.

Results

Of 28 randomised participants, 26 completed the study (13 per group). Text message delivery was high (99.2%), but fidelity of video delivery was low (57.1%). Most participants rated the messages as useful, supportive, encouraging, and engaging; 78.5% would recommend the intervention to others; and 64.2% desired a longer intervention period. Tapering self-efficacy (Cohen d = 0.74) and pain self-efficacy (d = 0.41) were higher, and pain intensity (d = 0.65) and affective interference (d = 0.45) were lower in the intervention group at week 4.

Conclusion

First evidence supports the feasibility, acceptability, and potentially efficacy of a psychoeducational video and SMS text messaging intervention to support patients with chronic pain during voluntary prescription opioid tapering. Definitive trials with longer intervention duration are warranted.

A digital health intervention to support patients with chronic pain during prescription opioid tapering: a pilot randomised controlled trial

Introduction

Recent changes in opioid prescribing guidelines have led to an increasing number of patients with chronic pain being recommended to taper. However, opioid tapering can be challenging, and many patients require support.

Objectives

We evaluated the feasibility, acceptability, and potential efficacy of a co-designed psycho-educational video and SMS text messaging intervention to support patients with chronic pain during prescription opioid tapering.

Methods

A pilot randomised controlled trial was conducted. In addition to their usual care, participants in the intervention group received a psycho-educational video and 28 days of text messages (two SMS/day). The control group received usual care. The feasibility, acceptability, and potential efficacy of the intervention were evaluated. The primary outcome was opioid tapering self-efficacy. Secondary outcomes were pain intensity and interference, anxiety and depression symptom severity, pain catastrophising, and pain self-efficacy.

Results

Of 28 randomised participants, 26 completed the study (13 in each group). Text message delivery was 99.2% successful. Most participants rated the messages as useful, supportive, encouraging, and engaging, 78.5% would recommend the intervention to others, and 64% desired a longer intervention period. Tapering self-efficacy (Cohen's d = 0.74) and pain self-efficacy (d = 0.41) were higher and pain intensity (d = 0.65) and affective interference (d = 0.45) lower in the intervention group at week 4.

Conclusions

It is feasible, acceptable, and potentially efficacious to support patients with chronic pain during prescription opioid tapering with a psycho-educational video and SMS text messaging intervention. A definitive trial has been initiated to test a 12-week intervention.

Talking to Teens about Pain: A Modified Delphi Study of Adolescent Pain Science Education

Background: Persistent pain is a prevalent condition that negatively influences physical, emotional, social and family functioning in adolescents. Pain science education is a promising therapy for adults, yet to be thoroughly investigated for persistent pain in adolescents. There is a need to develop suitable curricula for adolescent pain science education.

Methods: An interdisciplinary meeting of 12 clinicians and researchers was held during March 2018 in Adelaide, South Australia. An a priori objective of the meeting was to identify and gain consensus on key learning objectives for adolescent pain science education using a modified-Delphi process.

Results and Conclusion: Consensus was reached via a modified Delphi process for seven learning objectives to form the foundation of a curriculum: 1) Pain is a protector; 2) The pain system can become overprotective; 3) Pain is a brain output; 4) Pain is not an accurate marker of tissue state; 5) There are many potential contributors to anyone’s pain; 6) We are all bioplastic and; 7) Pain education is treatment. Recommendations are made for promising areas for future research in adolescent pain science education.

Can CT measures of tumour heterogeneity stratify risk for nodal metastasis in patients with non-small cell lung cancer?

AIM

To undertake a preliminary assessment of the potential for computed tomography (CT) measurement of tumour heterogeneity to stratify risk of nodal metastasis in patients with non-small cell lung cancer (NSCLC).

MATERIALS AND METHODS

Tumour heterogeneity in CT images from combined positron-emission tomography (PET)/CT examinations in 150 consecutive patients with NSCLC was assessed using CT texture analysis (CTTA). The short axis diameter of the largest mediastinal node was also measured. Forty-two patients without distant metastases subsequently had tumour nodal status confirmed at surgery (n=26) or endobronchial ultrasound (EBUS; n=16). CTTA parameters and largest nodal diameter were related to nodal status using the rank correlation and the risk ratio for each nodal stage (>N0, >N1, >N2) was compared between patients categorised as high and low risk by CTTA or nodal size. The most significant predictor of nodal status was related to overall survival using Kaplan-Meier analysis.

RESULTS

N-stage was more significantly correlated with CTTA than nodal diameter (Rs = -0.39, p=0.011, Rs = -0.45, p=0.0025, Rs = -0.40, p=0.0091 for normalised standard deviation (SD), normalised entropy and kurtosis respectively; Rs = -0.39, p=0.042 for nodal diameter). The presence of two or more high-risk CTTA values was the greatest risk factor for mediastinal metastasis (risk ratio: 11.0, 95% confidence interval: 1.56-77.8, p=0.0014) and was associated with significantly poorer overall survival (p=0.016).

CONCLUSION

CTTA in NSCLC is related to nodal status in patients without distant metastases and has the potential to inform selection of investigative strategies for the assessment of mediastinal malignancy.

Putting faces to names

An experiment is reported which investigated participants' ability to remember a person's face when they were presented with the person's name. During the learning phase, participants were shown 18 unfamiliar faces together with a name and occupation. At test, participants were presented with a name and were asked to indicate the face and occupation that had been presented with that name at learning. Results showed that participants' ability to remember the face was contingent upon their ability to remember the occupation that had been presented with the name. When participants were presented with a face and were asked to remember the name, performance was also contingent upon correctly remembering the associated occupation, consistent with the findings of McWeeny, Young, Hay & Ellis (1987). No such contingencies were apparent when participants were given an occupation and were asked to remember the associated name and face; participants frequently remembered the name but not the face, or the face without the name. These results are consistent with the serial access model of person identification proposed by Bruce & Young (1986), and with more recent developments proposed by Valentine, Brédart, Lawson & Ward (1991) and Craigie & Hanley (1993) in which there are no direct links between the representation of a person's name in memory and visual information about their facial appearance. The mnemonic strategies that were used by the participants during the learning phase of the experiment were also examined. These strategies help explain those few occasions on which participants appear to be able to link names to faces without identity-specific semantic information.

Access to visual information from a name is contingent on access to identity-specific semantic information

In this study, we investigated subjects' ability to retrieve information about a familiar person's facial appearance in response to seeing their name. Each famous name was associated with one of four occupations (sport, music, politics, and acting) and one of four distinctive facial features (beard, long hair, glasses, baldness). Subjects were asked to state which occupation, and which facial feature was associated with each name. The most important finding was that subjects were generally only able to recall the distinctive facial feature that a person possessed if they were also able to recall their occupation. Recall of the person's occupation, by contrast, was not contingent on remembering the person's facial appearance. These results suggest that there are no direct links between the representation of a person's name in memory and visual information about their facial appearance. The link appears to be indirect, and to be mediated by non-visual semantic information about the person, such as their occupation. This conclusion was also supported by an examination of the effects of biographical cues on subjects' ability to recall facial information that they had previously failed to recall. In a second experiment, subjects were presented with biographical details about famous people, and were asked to retrieve information about their face and name. Retrieval of facial information did not appear to be contingent on recall of the name, nor did recall of the name appear to be contingent on retrieval of facial information. On the basis of the results, an hierarchical model of name recognition is presented which is analogous to current models of face recognition (e.g. Bruce & Young, 1986).