3 research outputs found
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Pilot Feasibility of a Virtual Tai Chi Easy Intervention for Opioid Use Disorder, Anxiety, and Chronic Pain
Background: Opioid use disorder (OUD) is a public health crisis and disproportionately affects persons with chronic pain (CP) and anxiety. CP and anxiety are important contributors to OUD treatment discontinuation and relapse. Medication Assisted Treatment (MAT) (e.g., Suboxone, Methadone) is underutilized and approximately 50% of people discontinue treatment prematurely or relapse. Mind-body therapies (e.g., mindfulness, acupuncture, Tai Chi) help improve opioid use, anxiety, pain, self-efficacy, stress, and quality of life. However, the feasibility of Tai Chi to ameliorate cravings, anxiety, and CP symptoms among individuals with OUD is not known. This study examined the feasibility of an 8-week virtual Tai Chi Easy (vTCE) adjunct intervention for adults with OUD, CP, and anxiety. vTCE is a multi-component mind-body therapy, delivered remotely, including 1) Gentle movement, 2) Breath practice, 3) Self-massage, and 4) Meditation to improve intrinsic motivation and develop self-care tools for pain and emotional regulation.Methods: A theory-driven, pre-post, single-group, quasi-experimental design was used to undertake three study aims. Aim 1, determined the feasibility of vTCE intervention using feasibility criteria benchmarks. Aim 2, determined the perceptions of vTCE intervention using individual interviews. Aim 3, explored within-subject changes and baseline comparisons between inpatient and outpatient groups in generalized anxiety, CP intensity, opioid cravings, and basic psychological needs. A new holistic theoretical framework (Complexity of Opioid Use Disorder Model; COUDM) guided this project.
Results: Thirty-two individuals were screened for eligibility, 19 participants enrolled, and 15 individuals participated in an 8-week/16-session vTCE intervention. Recruitment was not efficient and did not meet the participant recruitment goal of 20 within two months. Only six (30% of the goal) participants from the inpatient detox setting were enrolled within two months. After study modifications to expand recruitment to the outpatient settings, an additional 13 (65% of goal) participants were successfully enrolled within one month. Retention was not met, of the 19 participants enrolled, only three (15.8%) were retained through the final assessment. The data collection goal was met for the pre-intervention survey (95% collected); however, due to high attrition (84.3%), only three participants from the outpatient setting completed the post-intervention survey. Adherence goal (retention after session 1) was not met (3/15, 20%). Intervention acceptability, appropriateness, and feasibility goals were less than the target. Average reported acceptability was 3.5/5, appropriateness was 3.5/5, and feasibility was 4/5 (i.e., three valid 4-item measures, 5-point Likert scale). The safety goal was met with 0% reported injury issues.
Conclusion: The 8-week vTCE intervention was not found to be feasible; however, when exploring the differences in implementing the vTCE in the outpatient vs. inpatient setting, there were notable differences in feasibility and reported opioid cravings at baseline. The lessons learned from this pilot study may contribute to the body of knowledge surrounding OUD and Tai Chi. Further investigation of the vTCE, as an adjunct to MAT, with a recorded delivery method, in the outpatient setting for adults with OUD is warranted
Changes in Psychological Outcomes after Cessation of Full Mu Agonist Long-Term Opioid Therapy for Chronic Pain
Improved understanding of psychological features associated with full mu agonist long-term opioid therapy (LTOT) cessation may offer advantages for clinicians. This preliminary study presents changes in psychological outcomes in patients with chronic, non-cancer pain (CNCP) after LTOT cessation via a 10-week multidisciplinary program which included treatment with buprenorphine. Paired t-tests pre- and post-LTOT cessation were compared in this retrospective cohort review of data from electronic medical records of 98 patients who successfully ceased LTOT between the dates of October 2017 to December 2019. Indicators of quality of life, depression, catastrophizing, and fear avoidance, as measured by the 36-Item Short Form Survey, the Patient Health Questionnaire-9-Item Scale, the Pain Catastrophizing Scale, and the Fear Avoidance Belief Questionnaires revealed significant improvement. Scores did not significantly improve for daytime sleepiness, generalized anxiety, and kinesiophobia, as measured by the Epworth Sleepiness Scale, the Generalized Anxiety Disorder 7-Item Scale, and the Tampa Scale of Kinesiophobia. The results suggest that successful LTOT cessation may be interconnected with improvements in specific psychological states
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Anxiety and Fear Avoidance Beliefs and Behavior May Be Significant Risk Factors for Chronic Opioid Analgesic Therapy Reliance for Patients with Chronic Pain-Results from a Preliminary Study
OBJECTIVE: To describe differences between patients with chronic, non-cancer pain (CNCP) who were successfully able to cease full mu agonist chronic opioid analgesic therapy (COAT), and those who exhibited refractory COAT reliance, among those who participated in a multidisciplinary program designed for COAT cessation. DESIGN: A retrospective review of electronic medical records (EMR) data was organized for preliminary analysis. SETTING: A multicenter private practice specializing in CNCP, which received patient referrals from the surrounding geographical area of primary and specialty care offices in Northern California. SUBJECTS: Data from 109 patients with CNCP who participated in a multidisciplinary program to cease COAT between the dates of October 2017 to December 2019 were examined. METHODS: EMR data, pre-COAT cessation, of oral morphine milligram equivalence (MME) and validated questionnaire responses assessing anxiety and fear-based beliefs and behavior, as well as opioid misuse, were extracted and compared between those who successfully ceased COAT and those who did not. RESULTS: Patients who were unsuccessful at COAT cessation reported significantly higher Fear Avoidance Beliefs Questionnaire (FAB) scores. No significant differences were found based on incoming MME amounts, Current Opioid Misuse Measure (COMM) or Tampa Scale of Kinesiophobia (TSK) scores. Pain Catastrophizing Scale (PCS) scores showed a split pattern with unclear significance. CONCLUSIONS: Results suggest that fear avoidance beliefs and behavior, as measured by the FAB, play a significant role in refractory COAT reliance for patients with CNCP.Open access articleThis item from the UA Faculty Publications collection is made available by the University of Arizona with support from the University of Arizona Libraries. If you have questions, please contact us at [email protected]