An Adaptive Psychological Intervention to Improve Pain and Reduce Opioid Use following an Injury - As many as 24% of the 6.8 million patients who seek treatment for a musculoskeletal injury each year continue opioid use long-term, which can lead to negative consequences including opioid use disorders, overdose, and death. Because tapering patients off chronic opioid use is challenging, interventions are needed to assist patients in opioid cessation during the acute pain phase. Pain and opioid use are impacted by modifiable psychological factors, yet there are no routine psychological treatments after an injury to mitigate these variables. The purpose of the proposed study is to optimize and examine feasibility and acceptability of an adaptive psychological intervention for patients who are medically hospitalized after an injury. The proposed adaptive intervention begins with a low-cost, low-intensity, 15-minute computerized brief intervention (CBI) in which participants will be provided with education on the consequences of long-term opioid use and complete a mindfulness activity to assist with managing pain. Those still using opioids after 10 days will engage in a more intensive, 4-session psychological intervention with a trained therapist. Sessions are composed of evidence-based strategies to improve pain and distress (i.e., mindfulness and acceptance-based strategies); however, these have not yet been used for acute pain after injury to transition patients off opioids. Without this early intervention, patients are high-risk for long-term opioid use. The CBI will begin inpatient, and if warranted, subsequent weekly sessions will follow inpatient or through telemedicine (e.g., video visits) once the patient is discharged. Patient interviews (N= 20) will be utilized to refine the adaptive intervention and study design. The intervention will be further revised based on therapist and participant feedback from an open trial (N= 10). A sequential, multiple assignment, randomized trial (SMART) of 80 patients will then be conducted to evaluate this adaptive intervention. Patients will first be randomized to CBI or the usual treatment comparison group. After 10 days, those remaining on opioids will begin a guided opioid taper. Non-responders in the CBI will also be re-randomized to receive only the opioid taper, or the opioid taper plus the 4-session psychological intervention. All participants will be evaluated at baseline, and at 10-day, 40-day, and 90-day follow-ups. We expect that this intervention and design will be feasible and acceptable. The results obtained from this study will be used as preliminary data to inform a fully powered SMART to test the efficacy of the adaptive psychological intervention. This project is innovative because it targets patients at high-risk for long-term opioid use during the acute pain stage, and uses a psychological intervention that adapts to individual needs. Further, the intervention will be evaluated with a SMART design through a real-world medical setting, which is expected to increase patient access and engagement. The long-term goal is to evaluate whether an adaptive psychological intervention delivered after a musculoskeletal injury can successfully transition patients off opioids and prevent prolonged opioid use and the development of an opioid use disorder.
