Chronic pain affects millions of Americans, and long-term opioid therapy (LOT) has been a common treatment approach. However, concerns about the risks associated with opioid use have led to a shift towards nonpharmacological chronic pain therapies. Opioid dose reduction, often termed opioid tapering, is a topic of significant importance in the U.S. due to the ongoing opioid crisis, which has been marked by high rates of opioid-related overdoses, deaths, and cases of opioid use disorder. Given the magnitude of the opioid crisis, several guidelines and regulations have been issued by entities like the Centers for Disease Control and Prevention to guide practitioners on safe prescribing practices. Nevertheless, the implementation of these recommendations remains a challenge, and there is a lack of standardized self-management materials and methods for clinicians to facilitate safe and effective opioid dose reduction. In this context, a recent study by Professor Marian Wilson from Washington State University, in collaboration with Dr. Daniel Lewis, Dr. Saundra Regan, Mary Beth Vonder Meulen, Professor T. John Winhusen from the University of Cincinnati, and Professor Rowena Dolor from Duke University, published in the Journal of Pain, investigated the impact of an E-health chronic pain management program on opioid dose reduction and various pain-related outcomes in individuals receiving LOT. “There is a significant need for reliable information for people struggling with pain,” said Wilson, a registered nurse and researcher. “While many online resources are available, it can be a challenge to know their quality and credibility.”
Self-management programs have shown promise in improving pain intensity and minimizing disability. Internet-based programs, such as the E-health program tested in the new study (https://www.mood.goalistics.com/), offer the potential for increased standardization and accessibility, making them a valuable tool for individuals with chronic pain. However, previous research has often overlooked the impact of such programs on opioid dose reduction, leaving a critical gap in our understanding of their effectiveness.
The authors included a diverse sample of participants, with similar demographic and baseline characteristics between the E-health and treatment as usual (TAU) groups. The primary outcome of the study was the reduction in daily morphine equivalent dose (MED), which is a crucial measure of opioid dose reduction. The results showed that the E-health group had a significantly greater proportion of participants achieving a 15% reduction in daily MED compared to the TAU group. This finding is of paramount importance as it demonstrates the potential of the E-health program to contribute to safer opioid use. “While many people do need opioids to assist with their pain relief, minimizing the dose required reduces the chance of adverse events, such as overdose,” Wilson said. Secondary outcomes from the study included evaluating pain intensity, pain interference on sleep, function, and mood, pain coping, pain self-efficacy, and global health. The authors found that E-health group exhibited favorable outcomes in several secondary measures, including a significant reduction in pain intensity and improvements in pain knowledge, pain self-efficacy, and pain coping. However, they did not find significant improvements in global physical or mental health or in opioid misuse as measured by the COMM score. According to the authors, program adherence was relatively high, with 68% of E-health participants receiving substantive exposure to the program. Adverse events were not significantly different between the E-health and TAU groups, indicating that the E-health program was safe to use.
The results of the randomized controlled trial conducted by the researchers offer valuable insights into the potential benefits of the E-health chronic pain management program for individuals receiving LOT. The findings support the program’s ability to facilitate opioid dose reduction, which aligns with the growing emphasis on reducing opioid use in chronic pain management. The E-health program’s success can be attributed to its comprehensive approach, which provides information on opioid risks, nonopioid alternatives, and pain self-management strategies. By enhancing patients’ knowledge and self-efficacy, the program empowers them to engage in shared decision-making conversations with healthcare providers regarding opioid use. Moreover, the accessibility and affordability of internet-based programs like E-health can address some of the existing barriers to nonpharmacological pain management, particularly for individuals with disabilities or those who face transportation challenges. The study’s strengths include its diverse sample and objective measurement of MED using electronic health records, which adds credibility to the program’s potential to reduce opioid use. Additionally, the E-health program’s impact on pain intensity and various aspects of pain-related outcomes underscores its potential as an effective tool in chronic pain management.
In conclusion, the study by Professor Marian Wilson and her colleagues presents compelling evidence of the positive impact of the E-health chronic pain management program on opioid dose reduction and pain-related outcomes in individuals receiving LOT. This research highlights the potential of internet-based self-management programs to enhance pain care and align with national objectives to reduce opioid use while improving pain management. The results suggest that integrating pain self-management education and tools like the E-health program into clinical practice could offer a valuable strategy for addressing the challenges associated with chronic pain and opioid therapy. Further research on implementation approaches and strategies to encourage program use is warranted to maximize the benefits of such interventions. “The important take-away message for people with chronic pain is that there are many strategies that can improve their situation, even if they cannot completely relieve the pain” Wilson said. “It often takes time to find the right combination of treatments and this can be frustrating. Pain self-management programs put the person with pain in the driver’s seat and helps build confidence so they can feel better and find more enjoyment in life.”
Wilson M, Dolor RJ, Lewis D, Regan SL, Vonder Meulen MB, Winhusen TJ. Opioid dose and pain effects of an online pain self-management program to augment usual care in adults with chronic pain: a multisite randomized clinical trial. Pain. 2023;164(4):877-885. doi: 10.1097/j.pain.0000000000002785.