2023-04-03 ワシントン州立大学(WSU)
約400人の参加者を2つのグループに分け、1つは通常治療を受け、もう1つは自己誘導型のe-ヘルスプログラムへのアクセスを提供された。e-ヘルスグループでは、6ヶ月後に53.6%がオピオイド薬剤を15%以上削減できたが、対照群の患者は42.3%だった。
このような自己管理プログラムは、患者の痛みレベルを追跡し、異なる戦略を試すことができるため、個人化された慢性疼痛治療の1つの選択肢となると考えられている。
<関連情報>
- https://news.wsu.edu/press-release/2023/04/03/e-health-reduces-patient-pain-opioids-in-clinical-study/
- https://journals.lww.com/pain/Fulltext/2023/04000/Opioid_dose_and_pain_effects_of_an_online_pain.24.aspx
慢性疼痛を抱える成人の通常ケアを補強するオンライン疼痛自己管理プログラムのオピオイド用量と疼痛効果:マルチサイト無作為化臨床試験 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
Wilson, Marian; Dolor, Rowena J.; Lewis, Daniel; Regan, Saundra L.; Vonder Meulen, Mary Beth; Winhusen, T. John
Pain Published:April 2023
DOI: 10.1097/j.pain.0000000000002785
Abstract
Readily accessible nonpharmacological interventions that can assist in opioid dose reduction while managing pain is a priority for adults receiving long-term opioid therapy (LOT). Few large-scale evaluations of online pain self-management programs exist that capture effects on reducing morphine equivalent dose (MED) simultaneously with pain outcomes. An open-label, intent-to-treat, randomized clinical trial recruited adults (n = 402) with mixed chronic pain conditions from primary care and pain clinics of 2 U.S. academic healthcare systems. All participants received LOT-prescriber-provided treatment of MED ≥ 20 mg while receiving either E-health (a 4-month subscription to the online Goalistics Chronic Pain Management Program), or treatment as usual (TAU). Among 402 participants (279 women [69.4%]; mean [SD] age, 56.7 [11.0] years), 200 were randomized to E-health and 202 to TAU. Of 196 E-heath participants, 105 (53.6%) achieved a ≥15% reduction in daily MED compared with 85 (42.3%) of 201 TAU participants (odds ratio, 1.6 [95% CI, 1.1-2.3]; P = 0.02); number-needed-to-treat was 8.9 (95% CI, 4.8, 66.0). Of 166 E-health participants, 24 (14.5%) achieved a ≥2 point decrease in pain intensity vs 13 (6.8%) of 192 TAU participants (odds ratio, 2.4 [95% CI, 1.2-4.9]; P = 0.02). Benefits were also observed in pain knowledge, pain self-efficacy, and pain coping. The findings suggest that for adults on LOT for chronic pain, use of E-health, compared with TAU, significantly increased participants’ likelihood of clinically meaningful decreases in MED and pain. This low-burden online intervention could assist adults on LOT in reducing daily opioid use while self-managing pain symptom burdens.
