Telemedicine-delivered digital cognitive behavioral intervention to decrease post-operative opioid use among patients undergoing total knee and hip arthroplasty

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.

Grant Number: 5R21DA061414-02
NIH Institute/Center: NIH
Principal Investigator: Jacques Chelly