Understanding Motivational Biases to Promote Opioid Tapering in Chronic Pain Patients
Abstract
Many Service Members (SMs) and Veterans suffer from lower back and/or joint pain. This pain can be unbearable, become chronic, and lead to disability. Acute treatment with daily opioid therapies can reduce pain. However, long-term opioid therapy (LTOT) can lead to addiction, cause severe side effects, and make pain worse. Talk therapies and other non-opioid medications can also reduce pain and are readily available in Department of Defense (DOD) and Department of Veterans Affairs (VA) health systems. Some SMs and Veterans are willing to taper LTOT and try talk therapy and non-opioid medications to manage pain and avoid addiction. Other SMs and Veterans are of two minds about stopping LTOT and trying other treatments. Some fear addiction or endure unpleasant opioid side effects but believe that only opioids will relieve their pain and allow them to function. Some avoid change because they view tapering opioids and trying other treatments as too risky. Some won’t risk tapering opioids and the likely possibility of feeling increased pain in the short-term all for an uncertain benefit of having less pain and better life quality down the road. How SMs and Veterans act on their perceptions of gains (rewards) and losses (risks) -- known as motivational biases -- is not well-studied in military pain populations. Such research can determine how SMs and Veterans think about LTOT tapering and their chances of having good or bad outcomes. This knowledge can then inform protocols to help providers know the best way to talk with SMS and Veterans about tapering LTOT and motivating them to try safer pain treatments. For example, we recently found that sensitivity to reward outcomes in a special risk-taking game predicted how well Veterans with paraplegia took care of their health. Our project, Understanding Motivational Biases to Promote Opioid Tapering in Chronic Pain Patients, will study how Veterans who are treated with LTOT for chronic pain but who are reluctant to taper make decisions about rewards and risks. We will compare their patterns of choices (motivational biases) with other Veterans of similar age who either don’t have chronic pain, or who have chronic pain but manage it without opioids. We will uncover differences between these groups in choices when presenting clear versus vague information on chances of gains and losses. For example, when we do not show the odds of good or bad things happening when choices have to be made, do Veterans who do not want to taper LTOT expect the worst? We will also look at differences in choices when the timing (immediate or delayed) and size (small or large) of gains and losses are changed. For example, do LTOT patients who don t want to taper want results or outcomes now, even more than most people do? Lastly, we will use special computational modeling to compare how recent history of positive and negative events in a card-playing game shape behavior. This project has high clinical relevance. Knowing what motivates Veterans or SMs who are reluctant to taper LTOT (beyond basic fear of worse pain) is a critical knowledge gap. Providers see the value of getting SMs and Veterans to taper opioids and try other therapies. However, they dread talking to LTOT patients about tapering opioids, fearing bad reactions even if they have good rapport. Knowledge of SMs and Veterans views of gains and losses can inform development of evidence-based brief scripts or better talking points for providers that make the most effective case for opioid tapering. Such brief scripts on opioid tapering can then be tested in future clinical studies. If successful, these scripts can make chronic pain treatment safer and more effective. Adoption could be achieved through inclusion in the VA/DOD Clinical Practice Guideline for the Use of Opioids in the Management of Chronic Pain.
Document Details
- Document Type
- DoD Grant Award
- Publication Date
- Jan 04, 2024
- Source ID
- HT94252310645
Entities
People
- James M Bjork
Organizations
- United States Army
- Virginia Commonwealth University