Chatbots delivering psychotherapy help decrease opioid use after surgery


Date:
August 17, 2020
Source:
University of Pennsylvania School of Medicine
Summary:
A study showed that patients receiving messages from a chatbot used
a third fewer opioids after fracture surgery, and their overall
pain level fell, too.



FULL STORY ========================================================================== Patients who need surgery to fix major bone fractures use fewer opioid
pills after their procedure if they're reminded of their values -- and
those reminders don't necessarily need to come from a doctor, according
to a new study published in the Journal of Medical Internet Research.


==========================================================================
"We showed that opioid medication utilization could be decreased by more
than a third in an at-risk patient population by delivering psychotherapy
via a chatbot," said the study's lead author, Christopher Anthony,
MD, the associate director of Hip Preservation at Penn Medicine and an assistant professor of Orthopaedic Surgery. "While it must be tested with future investigations, we believe our findings are likely transferrable
to other patient populations." Although opioids can be appropriate to
treat the pain that results from an injury like a broken leg or arm,
there is a concern that a large prescription of opioids might be an
on-ramp to dependence for many. The researchers -- who included Edward
Octavio Rojas, MD, a resident in Orthopaedic Surgery at the University
of Iowa Hospitals & Clinics -- believe a low-effort, patient- centered
approach to reducing the number of opioids taken can be a valuable method
for cutting into the opioid epidemic.

To test this approach, 76 patients who went to a Level 1 Trauma Center at
the University of Iowa Hospitals & Clinics for fractures that required
a surgery to fix were randomly divided into two groups. Although each
group received the same prescription of an opioid medication for pain,
just one group was enrolled in a daily text-messaging program. That
group received two daily text messages to their phones for two weeks
after their procedure from an automated "chatbot" -- a computer that
uses artificial intelligence to send messages -- starting the day after
their surgery. The goal of each message was to help focus patients and
hone their coping skills for the inevitable pain after such a procedure.

While they don't expressly discourage using opioid pills, the messages, designed by a pain psychologist who specialized in acceptance and
commitment therapy (ACT), are designed to direct thoughts away from
taking a painkiller.

Each message fell under one of six "core principles": Values, Acceptance, Present Moment Awareness, Self-As-Context, Committed Action, and
Diffusion.

So, for example, a message a patient could receive under the Acceptance principle could be: "Feelings of pain and feelings about your experience
of pain are normal after surgery. Acknowledge and accept these feelings
as part of the recovery process. Remember how you feel now is temporary
and your healing process will continue. Call to mind pleasant feelings
or thoughts that you experienced today." Or a Committed Action message
might urge a patient to work toward a life goal, even if some pain might
be present.

Overall, the patients who didn't receive the messages took 41
opioid tablets after their surgeries, on average. The group who were
regularly contacted by the chatbot averaged just 26, a 37 percent
difference. Moreover, they reported less pain, overall, just two weeks
after their procedure.

Importantly, the messages each patient received were not curated for their individual personality. This type of effectiveness was seen without the messages needing to be overly personalized. Combined with the using a
chatbot instead of a human-intensive effort, this could be a low-cost, low-effort for orthopaedic and other procedures that provides significant protection from opioid dependence.

"A realistic goal for this type of work is to decrease opioid utilization
to as few tablets as possible, with the ultimate goal being to eliminate
the need for opioid medication in the setting of fracture care,"
Anthony said.

This study was funded by a grant from the Orthopaedic Trauma Association.

Co-authors included Valerie Keffala, PhD; Natalie Ann Glass, PhD;
Benjamin J.

Miller, MD; Mathew Hogue, MD; Michael Wiley, MD; Matthew Karam, MD;
and John Lawrence Marsh, MD, all of the University of Iowa, as well as
Apurva Shah, MD, of the Children's Hospital of Philadelphia.


========================================================================== Story Source: Materials provided by University_of_Pennsylvania_School_of_Medicine. Note: Content may be
edited for style and length.


========================================================================== Journal Reference:
1. Chris A Anthony, Edward Octavio Rojas, Valerie Keffala, Natalie Ann
Glass, Apurva S Shah, Benjamin J Miller, Matthew Hogue, Michael
C Willey, Matthew Karam, John Lawrence Marsh. Acceptance and
Commitment Therapy Delivered via a Mobile Phone Messaging Robot
to Decrease Postoperative Opioid Use in Patients With Orthopedic
Trauma: Randomized Controlled Trial. Journal of Medical Internet
Research, 2020; 22 (7): e17750 DOI: 10.2196/17750 ==========================================================================

Link to news story: https://www.sciencedaily.com/releases/2020/08/200817144122.htm

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