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Study to Examine Opioid Use, Chronic Pain Patients

Opioid Use and Chronic Pain 480

A new Cedars-Sinai study will use computer alerts to prompt doctors to speak with other patients before renewing opioid prescriptions.

Cedars-Sinai investigators are gearing up to study the most effective ways for doctors to discuss opioid use with chronic pain patients in an effort to reduce the impact of pain while curbing overuse of these addictive drugs.

The research team has received $2 million from the Patient-Centered Outcomes Research Institute to conduct the study, which will launch this year.

The new research effort comes as patients, doctors, law enforcement authorities and others struggle with an opioid overdose epidemic in the U.S. that claimed more than 33,000 lives in 2015, according to the Centers for Disease Control and Prevention. Opioid-related deaths have quadrupled since 1999, driven partly by overdoses from prescription pain relievers in a country where more than 100 million people suffer from chronic pain.

"More people die of drug overdoses in the U.S. than car accidents or guns. This sobering statistic reveals a massive, nationwide epidemic of opioid addiction that is costing lives and money," said Brennan M. Spiegel, MD, director of Cedars-Sinai Health Services Research, who will lead the team. "Our study will test whether we can use the electronic health record to disrupt how pain treatments are discussed and managed between patients and providers, with the goal of reducing inappropriate overuse of opioids."

When aiming to limit opioid use, most studies may rely on prescription claims data to gauge results. The Cedars-Sinai project is different because it also will use patient feedback, which is critical for successful management of chronic pain.

Working with patients, consumer advocates, addiction specialists and primary care providers, the team will spend a year comparing the effectiveness of two established communication strategies used by doctors who treat chronic pain patients. Educational material will be shared with some of the patients prior to office visits, while computer alerts will prompt doctors to speak with other patients before renewing opioid prescriptions.

Investigators will survey all patients one month after their visits to gauge their quality of life, overall health (including pain, fatigue, energy and concentration) and how well communications with their doctors have worked. The study also will capture pain medication use through electronic health records and pharmaceutical claims data. Program direction will be overseen by Michelle S. Keller, MPH.

"Incorporating patients' perspectives into the study design ensures that the findings will be relevant to real people in general medical practices, and not just some highly selected sample," said Itai Danovitch, MD, MBA, chair of the Department of Psychiatry and director of Addiction Psychiatry at Cedars-Sinai. "The focus on assessing quality of life means the study will extend beyond evaluating symptoms and will tell us whether the interventions impact health in a way that patients themselves find meaningful."

The Patient-Centered Outcomes Research Institute is an independent, nonprofit organization authorized by Congress in 2010 to fund research that will provide patients, their caregivers and clinicians with evidence-based information needed to make better-informed healthcare decisions.