User-Centered Development of An App-Based Cognitive-Behavioral Intervention to Reduce Persistent Opioid Use and Opioid-Related Problems Following Spine Surgery

Chronic back pain (CBP) is the leading cause of disability worldwide. As many as 24% of patients report aberrant medication-taking behaviors, and 14-19% of patients meet criteria for addiction. Spine surgery offers potential for substantial relief from CBP and has become one of the most common surgeries in the United States. However, 10-40% of patients who undergo spine surgery experience persistent impairment. Approximately half of individuals who used opioids preoperatively continue to report persistent opioid use 3-12 months post-surgery, and 7.5% of previously opioid-naïve patients initiate long-term opioid use. Analgesic poisoning including accidental and non-accidental overdose is the leading cause of mortality after lumbar fusion surgery, highlighting the acute need for interventions that address modifiable risk factors for opioid-related problems.

With collaborators in the Department of Neurosurgery at Dartmouth-Hitchcock Medical Center, we are developing a mobile app to deliver tailored Cognitive Behavioral Therapy for patients undergoing spine surgery. In Aim 1, we will elicit feedback on a prototype of the app from patients who underwent spine surgery within the past 3 months and experience persistent opioid use. In Aim 2, we will pilot the refined app among patients undergoing spine surgery, focusing on the high-risk group of patients who use opioids prior to surgery. We will collect qualitative and quantitative information on feasibility and acceptability to further refine the intervention prior to examining efficacy in a fully powered randomized controlled trial. If successful, our highly scalable approach can be broadly disseminated and applied to other surgical contexts to prevent persistent pain, impairment, and opioid use after surgery.