JMIR Publications

ABSTRACT

Background:

More than 300 million surgical procedures are performed worldwide each year, and opioids remain a primary approach for managing acute postoperative pain. Studies have demonstrated that a significant number of patients do not discontinue opioid treatment and continue to use opioids for months or even years after surgery. Tapering and management of prescription opioids is a well-known practice and is a part of the current clinical guidelines on safe prescribing. Every patient should receive thorough monitoring, education, and a tapering plan when prescribed opioids or receiving refills after a prolonged treatment. There are challenges associated with tapering, including close follow-up, patient education, clinician time, and withdrawal safety. The evolution of smartphone app use for follow-up has shown promising results in some fields of medicine, and patients are increasingly interested in this approach.

Objective:

The objective of this study is to investigate the efficacy and safety of the Prescriby Clinic and digital support in the form of a software with a patient and clinician facing application as a tapering intervention in patients after knee or hip replacement surgery.

Methods:

Efficacy for the outcomes will be measured in tapers successfully completed, doses successfully lowered during tapering, number of active users, satisfaction with the intervention. Participant safety will be monitored by assessing adverse effects during tapering using the numeric pain rating scale to assess the severity of pain. Participants are recruited via referrals from orthopedic departments in the hospital after surgery during the 7-month study period to the Prescriby clinic, where they will receive a personalized tapering treatment and follow-up with a clinical pharmacist.

Results:

All in all, 75 patients were enrolled during the 7-month enrollment period of which two were lost to follow-up, so 73 finished the tapering program. Out of these, 57.5% were female, with an average age of 65. Out of 73 patients who received tapering treatment, 72 patients completely tapered off their opioid medication, while 1 patient tapered down to the same dose as before treatment. The average medication starting dose in morphine milligram equivalents (MME) was 21.55 MME (range: 4.5 - 60). The average duration of taper was 23.7 days (range: 7-97 days). The average adherence was 51% of days, and 42.2% of patients can be described as “active users” with over 75% adherence to usage. Agreeableness with positive statements on the service was on average between "agree" and “agree a little”, leaning closer to “agree”.

Conclusions:

Age distribution and gender ratio comparable to patients who usually undergo elective hip- and knee replacement. Comorbidities are comparable to similar groups in other countries with a few exceptions. Tapering length was reasonable and patient adherence was acceptable with room for improvement. Patient experience is great overall. The support clinic proved to be an essential part in this pain management during tapering, which led to more personalization for each patient not only at the start of tapering, but throughout the tapering progress. Clinical Trial: The National Bioethics Committee of Iceland has given approval for a study. This study has been given the registration number VSNb2024090010/03.01.