Practical Clinical Trials Could Help Address Opioid Epidemic

Widespread use of multidisciplinary pain care helps lower opioid misuse.

To combat the opioid epidemic and reduce the misuse of pain killers, widespread use of practical clinical trials and more of an emphasis on patient self-management could be key, according to a senior investigator for Kaiser Permanente.

From 2002 to 2015, there was a 2.8-fold increase in the number of deaths from opioid drugs, with more than 30,000 overdose deaths in 2015, according to the National Institute on Drug Abuse.

The figures are staggering and unfortunately a small minority of pain patients are represented in this mortality data.

“Given the justified apprehensions of primary care doctors to continue prescribing opioids, the central question focuses on what can we do in primary care to help improve function for pain patients,” said senior investigator Lynn DeBar, PhD, at the American Pain Society annual scientific conference.

Although the benefits of multidisciplinary pain care have been well documented in peer-reviewed studies, it remains widely unavailable due to inadequate insurance coverage.

“Medicare and other health insurance providers need value-based care metrics and outcomes, and more studies are needed to help implement evidence-based multimodal pain care with attention to feasibility and sustainability in everyday clinical practice,” DeBar said.

The widespread gap in evidence-based information regarding pain management highlights the need for practical clinical trials that meet clinicians’ needs and answer their questions, according to DeBar.

Practical clinical trials are of interest to the National Institutes of Health, who are increasing their efforts to support pragmatic trial initiatives.

“Practical clinical trials can bridge the gap between research and clinical care,” DeBar said. “Traditional randomized clinical trials are slow and expensive, and results often cannot be implemented easily in clinical practice. Findings can be difficult to translate into the real world because treatments are given to carefully selected populations in ideal conditions.”

However, practical clinical trials take place in settings where routine medical care occurs, and are designed to improve practice and policy. According to DeBar, they answer real-world clinical questions and test what will be most successful in everyday care. Additionally, these trials study diverse populations using broadly inclusive eligibility criteria.

“Engaging health systems, provider[s], and patients as partners in pragmatic research accelerates realistic integration of research, policy, and practice,” DeBar said.

Currently, Kaiser Permanente is organizing a practical clinical trial in pain management that involves 851 patients.

DeBar also highlighted the benefits of adopting alternative treatment approaches, such as virtual reality and patient-to-patient reinforcement methods.

“Remote interventions with cognitive behavioral therapies are proving effective and so are new smart phone apps that allow patients to transmit real-time information about their pain,” Debar said. “Also, more attention should be given to patient-driven models of support, similar to programs like Weight Watchers, which empower patients to take more active roles in managing their care.”