Background & Aims
Increases in pain and interference with quality of life is a common concern among people with chronic non-cancer pain (CNCP) who are tapering opioid medications. Research indicates that access to social and psychological support for pain self-management may help people to reduce their opioid dose without increasing pain and interference. This study evaluates the efficacy of a text messaging intervention designed to provide people with CNCP with social and psychological support for pain self-management while tapering long-term opioid therapy (LTOT) under the guidance of their prescriber.
Methods
In this double-blind randomised controlled trial, patients with CNCP who are tapering LTOT are enrolled from across Australia. Participants continue with their usual care while tapering LTOT under the supervision of their prescribing physician. They randomly receive either a psycho-educational video and supportive text messaging (two SMS per day) for 12 weeks or the video only. The primary outcome is the pain intensity and interference assessed by the Pain, Enjoyment of Life and General Activity (PEG) scale. Secondary outcomes include mood, self-efficacy, pain cognitions, opioid dose reduction, withdrawal symptoms, and acceptability, feasibility, and safety of the intervention. Participants complete questionnaires at baseline and then every four weeks for 12 weeks.
Results
An interim analysis (using 90% one-sided Confidence Interval approach) was conducted on data of 45 patients who have received the allocated intervention and provided at least one follow-up assessment; including 73% female with mean age of 63 years (SD 12), pain duration of 17 years (SD 12), and opioid therapy duration of 12 years (SD 10). In the intervention group and after 12 weeks (vs. baseline), there was a reduction in PEG scale total score (estimate [CI90%] -1.97 [, -1.27]) and sub-scales of pain intensity (estimate [CI90%] -1.44 [, -0.76]) and pain interference with enjoyment of life (estimate [CI90%] -2.39 [, -1.57]) and pain interference with general activity (estimate [CI90%] -2.24 [, -1.44]). In the control group, there was a reduction in PEG scale total score (estimate [CI90%] -0.96 [, -0.34]) and sub-scales of pain interference with enjoyment of life (estimate [CI90%] -1.35 [, -0.62]) and pain interference in general activity (estimate [CI90%] -1.13 [, -0.42]). At week 12, PEG scale total score (estimate [CI90%] -0.89 [, -0.24]) and sub-scales of pain intensity (estimate [CI90%] -1.15 [, -0.48]) and pain interference with general activity (estimate [CI90%] = -0.80 [, -0.02]) were lower in the intervention vs. control group.
Conclusions
A mobile delivered text messaging program seems to be an efficacious intervention in improving pain in patients living with chronic pain who are reducing/tapering their opioid medications. This low-cost intervention can be implemented at scale to deliver education and support to patients, particularly in remote and regional areas where there is lack of access to quality pain care.
References
Dowell D, Ragan KR, Jones CM, et al. CDC Clinical Practice Guideline for Prescribing Opioids for Pain – United States, 2022. MMWR Recomm Rep. 2022;71:1-95.
Gholamrezaei A, Magee MR, McNeilage AG, et al. Text messaging intervention to support patients with chronic pain during prescription opioid tapering: protocol for a double-blind randomised controlled trial. BMJ Open. 2023;13:e073297.
Gholamrezaei A, Magee MR, McNeilage AG, et al. A digital health intervention to support patients with chronic pain during prescription opioid tapering: a pilot randomised controlled trial. medRxiv [Preprint]. doi: 10.1101/2023.05.10.23289771.
Magee MR, Gholamrezaei A, McNeilage AG, et al. A Digital Video and Text Messaging Intervention to Support People With Chronic Pain During Opioid Tapering: Content Development Using Co-design. JMIR Form Res. 2022;6:e40507.
McNeilage AG, Avery NS, Holliday S, et al. A qualitative trajectory analysis of patients’ experiences tapering opioids for chronic pain. Pain. 2022;163:e246-e260.
Magee MR, McNeilage AG, Avery N, et al. mHealth Interventions to Support Prescription Opioid Tapering in Patients With Chronic Pain: Qualitative Study of Patients’ Perspectives. JMIR Form Res. 2021;5:e25969.
Avery N, McNeilage AG, Stanaway F, et al. Efficacy of interventions to reduce long term opioid treatment for chronic non-cancer pain: systematic review and meta-analysis. BMJ. 2022;377:e066375.
Ashton-James CE, Glare P, Darnall BD. Out of office hours: scalable, on-demand, digital support for patients tapering prescription opioids. Pain. 2020;161:2252-2254.
Presenting Author
Paul Glare
Poster Authors
Paul Glare
MD
University of Sydney
Lead Author
Ali Gholamrezaei
The University of Sydney
Lead Author
Michael Magee
The University of Sydney
Lead Author
Amy McNeilage
The University of Sydney
Lead Author
Leah Dwyer
Painaustralia
Lead Author
Hassan Jafari
King's College London
Lead Author
Alison Sim
The University of Sydney
Lead Author
Manuela Ferreira
The George Institute for Global Health
Lead Author
Beth Darnall
Stanford University
Lead Author
Claire Ashton-James
The University of Sydney
Lead Author
Topics
- Access to Care