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Principal Investigator: Jacques E. Chelly
Organization: UNIVERSITY OF PITTSBURGH AT PITTSBURGH
Fiscal Year: 2024
Award: $238,500
Funding agency: National Institute on Drug Abuse
PROJECT SUMMARY: Postoperative opioid prescription is an important contributor to the opioid epidemic,
affecting ~4% of >50 million Americans undergoing surgery each year. The dose and duration of treatment with
opioids in surgical patients is an established risk factor of opioid use disorder (OUD) and overdose deaths.
Although legislation and guidelines are developed to limit opioids prescribed following surgery in the US, in
2020, opioid overdose deaths increased by 39% with worsening mental health. Mood disorders, including
anxiety and depression, are risk factors for increased postoperative opioid use. Thus, innovative and effective
techniques to minimize the perioperative opioid use are critical in the fight of the opioid epidemic.
Cognitive behavioral intervention (CBI) has been proven to decrease acute and chronic pain as well as opioid
use among surgical patients. Recently, digital applications of CBI, the dCBI, is getting traction among
practitioners and patients due to ease of access via smartphones and 24/7 availability. The dCBI along with
telemedicine-based therapy coaches to treat anxiety among patients with inflammatory bowel disease proved
success. The availability of telemedicine-delivered digital CBI is a potential groundbreaking non-
pharmacological approach to limit opioid use among surgical patients. Our proposed work is also responsive
to NOT-DA-20-058 “Utilizing Telemedicine or Other Remote-Based Platforms to Develop and Support
Treatments for Substance Use Disorders.” Our pilot data using dCBI in conjunction with telemedicine among
moderately anxious and depressed patients scheduled for total hip and total knee arthroplasty (THA/TKA) is
supportive that dCBI was effective in reducing preoperative anxiety with a trend of decreased opioid use
postoperatively. Our central hypothesis is that the preoperative telemedicine-delivered dCBI will decrease
perioperative anxiety, depression, and pain catastrophizing in THA/TKA patients. Preoperative dCBI will
reduce severe postoperative pain, overall reduce opioid use, opioid-related complications, chronic persistent
surgical pain, and persistent opioid use at 3 months after surgery. Anxiety, depression, and catastrophizing
increase postoperative pain and opioid requirement by up to 50% and since dCBI reduces mood disorder
symptoms, we also hypothesized that using dCBI will also reduce anxiety, depression, catastrophizing and that
could represent a mechanism for decreased postoperative opioid requirements. Our team is well positioned to
perform this project and will 1) quantify opioid sparing properties of dCBI i n T H A / T K A u s i n g a
randomized, blinded clinical trial, 2) evaluate effects of reducing preoperative depression, anxiety and
catastrophizing, and 3) determine the effects of dose/time relationship of the preoperative dCBI on opioid
consumption. This research will improve surgical pain relief, safety of postoperative opioids while minimizing
opioid use, dependence, and risk of OUD in millions of Americans who have painful surgeries each year,
while increasing broad reach and dissemination potential via telemedicine technologies.
Terms: <Absence of pain sensation><Absence of sensibility to pain><Acute><Acute Pain><Adverse effects><Affect><Affective Disorders><American><Anxiety><Blinded><COVID crisis><COVID epidemic><COVID pandemic><COVID-19 crisis><COVID-19 epidemic><COVID-19 era><COVID-19 global health crisis><COVID-19 global pandemic><COVID-19 health crisis><COVID-19 pandemic><COVID-19 period><COVID-19 public health crisis><COVID-19 years><Cell Phone><Cellular Phone><Cellular Telephone><Cessation of life><Chronic><Chronic pain syndrome><Client satisfaction><Clinical Trials><Cognition Therapy><Cognitive Psychotherapy><Cognitive Therapy><Cognitive treatment><Coxa><Data><Death><Dependence><Development><Dose><Effectiveness><Feels no pain><Guidelines><Head><Hip><Hip Prosthesis Implantation><Hip region structure><Inflammatory Bowel Diseases><Inflammatory Bowel Disorder><Knee arthroplasty><Knee joint replacement operation><Knee replacement><Knowledge><Legislation><Length><Mental Depression><Mental Health><Mental Hygiene><Mobile Phones><Mood Disorders><No sensitivity to pain><Non-pharmacologic Therapy><Nonpharmacologic Intervention><Nonpharmacologic Therapy><Nonpharmacologic approach><Nonpharmacologic treatment><Operative Procedures><Operative Surgical Procedures><Opiates><Opioid><Oral><Orthopedic Surgery><Outcome><Overdose><Pain><Pain Control><Pain Therapy><Pain management><Painful><Patient Satisfaction><Patient Schedules><Patients><Perioperative><Position><Positioning Attribute><Post-Operative><Post-operative Pain><Postoperative><Postoperative Pain><Postoperative Period><Procedures><Property><Psychological Health><Randomized><Research><Research Resources><Resources><Risk><Risk Factors><Role><SARS-CoV-2 epidemic><SARS-CoV-2 global health crisis><SARS-CoV-2 global pandemic><SARS-CoV-2 pandemic><SARS-coronavirus-2 epidemic><SARS-coronavirus-2 pandemic><Safety><Severe Acute Respiratory Syndrome CoV 2 epidemic><Severe Acute Respiratory Syndrome CoV 2 pandemic><Severe acute respiratory syndrome coronavirus 2 epidemic><Severe acute respiratory syndrome coronavirus 2 pandemic><Severities><Statutes and Laws><Substance Use Disorder><Surgical><Surgical Interventions><Surgical Procedure><Symptoms><Techniques><Technology><Telemedicine><Testing><Time><Total Knee Replacement><Traction><Treatment Period><Work><adverse consequence><adverse outcome><analgesia><anxiety reduction><anxious><chronic pain><chronic pain condition><chronic pain disorder><chronic pain patient><chronic painful condition><cognitive behavior intervention><cognitive behavior modification><cognitive behavior therapy><cognitive behavioral intervention><cognitive behavioral modification><cognitive behavioral therapy><cognitive behavioral treatment><compare intervention><comparison intervention><coronavirus disease 2019 crisis><coronavirus disease 2019 epidemic><coronavirus disease 2019 global health crisis><coronavirus disease 2019 global pandemic><coronavirus disease 2019 health crisis><coronavirus disease 2019 pandemic><coronavirus disease 2019 public health crisis><coronavirus disease crisis><coronavirus disease epidemic><coronavirus disease pandemic><coronavirus disease-19 global pandemic><coronavirus disease-19 pandemic><cost><depressed patient><depression><developmental><digital><digital app><digital applications><digital delivery><digitally deliver><evidence base><experience><fighting><high risk><hip arthroplasty><hip joint replacement><hip replacement><hip replacement arthroplasty><iPhone><improved><inflammatory disease of the intestine><inflammatory disorder of the intestine><innovate><innovation><innovative><intestinal autoinflammation><knee replacement arthroplasty><licit opioid><morphine equivalence><morphine equivalent><multidisciplinary><non-drug therapy><non-drug treatment><nondrug therapy><nondrug treatment><novel><opiate consumption><opiate crisis><opiate deaths><opiate drug use><opiate intake><opiate medication><opiate mortality><opiate use><opiate use disorder><opioid consumption><opioid crisis><opioid deaths><opioid drug use><opioid epidemic><opioid intake><opioid medication><opioid mortality><opioid overdose death><opioid related death><opioid sparing><opioid tapering><opioid use><opioid use disorder><overdose death><overdose fatalities><pain after surgery><pain catastrophizing><pain relief><pain treatment><pandemic><pandemic disease><patient with chronic pain><post-surgical pain><postsurgical pain><prescribed opiate><prescribed opioid><prescription opiate><prescription opioid><prospective><psychologic><psychological><public health relevance><randomisation><randomization><randomly assigned><relieve pain><severe acute respiratory syndrome coronavirus 2 global health crisis><severe acute respiratory syndrome coronavirus 2 global pandemic><smart phone><smartphone><social role><standard of care><substance use and disorder><substance use treatment><success><surgery><surgery pain><surgical pain><telehealth><tool><total knee arthroplasty><treatment days><treatment duration><trend>