The development and piloting of a mobile health (mHealth) intervention to support patients with chronic pain to taper prescription opioid medications
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Type
ThesisThesis type
Doctor of PhilosophyAuthor/s
Magee, Michael ReeceAbstract
Background: Clinical guidelines advise against long-term opioid therapy for chronic
noncancer pain (CNCP), yet tapering opioids is difficult without adequate support. Mobile
health (mHealth) interventions may meet a need for scalable, accessible tapering support.
Objective: ...
See moreBackground: Clinical guidelines advise against long-term opioid therapy for chronic noncancer pain (CNCP), yet tapering opioids is difficult without adequate support. Mobile health (mHealth) interventions may meet a need for scalable, accessible tapering support. Objective: This thesis describes the co-design and piloting an mHealth intervention to support opioid tapering in CNCP. Methods: The thesis includes (1) a scoping review of mHealth interventions for CNCP and opioid tapering, (2) a qualitative study of patient attitudes and recommendations to mHealth support, (3) a co-design study with 12 patients and 12 clinicians to develop the intervention, (4) a protocol detailing study objectives and methods, and (5) a pilot randomised controlled trial (RCT) to meet the objectives and inform improvements. Results: The scoping review revealed scarce research on mHealth interventions for opioid tapering in CNCP. Patient feedback supported the acceptability and potential benefit of text message mHealth supports. The co-design study developed a video and 28-day, twice-daily text intervention, which was considered useful, appropriate, and likely to be effective in supporting tapering. The pilot RCT recruited 28 participants. The mHealth intervention demonstrated acceptability and feasibility but had recruitment challenges. After four weeks, improvements in opioid tapering self-efficacy, pain self-efficacy, and pain intensity in the intervention group, versus the control group, demonstrated preliminary efficacy. Implementation analysis informed recommendations for a future definitive RCT. Conclusion: The thesis introduces one of the first mHealth interventions to support opioid tapering in CNCP. The mHealth intervention’s acceptability and preliminary efficacy were demonstrated, though addressing recruitment challenges and other feasibility issues should support scaling the intervention.
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See moreBackground: Clinical guidelines advise against long-term opioid therapy for chronic noncancer pain (CNCP), yet tapering opioids is difficult without adequate support. Mobile health (mHealth) interventions may meet a need for scalable, accessible tapering support. Objective: This thesis describes the co-design and piloting an mHealth intervention to support opioid tapering in CNCP. Methods: The thesis includes (1) a scoping review of mHealth interventions for CNCP and opioid tapering, (2) a qualitative study of patient attitudes and recommendations to mHealth support, (3) a co-design study with 12 patients and 12 clinicians to develop the intervention, (4) a protocol detailing study objectives and methods, and (5) a pilot randomised controlled trial (RCT) to meet the objectives and inform improvements. Results: The scoping review revealed scarce research on mHealth interventions for opioid tapering in CNCP. Patient feedback supported the acceptability and potential benefit of text message mHealth supports. The co-design study developed a video and 28-day, twice-daily text intervention, which was considered useful, appropriate, and likely to be effective in supporting tapering. The pilot RCT recruited 28 participants. The mHealth intervention demonstrated acceptability and feasibility but had recruitment challenges. After four weeks, improvements in opioid tapering self-efficacy, pain self-efficacy, and pain intensity in the intervention group, versus the control group, demonstrated preliminary efficacy. Implementation analysis informed recommendations for a future definitive RCT. Conclusion: The thesis introduces one of the first mHealth interventions to support opioid tapering in CNCP. The mHealth intervention’s acceptability and preliminary efficacy were demonstrated, though addressing recruitment challenges and other feasibility issues should support scaling the intervention.
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Date
2025Rights statement
The author retains copyright of this thesis. It may only be used for the purposes of research and study. It must not be used for any other purposes and may not be transmitted or shared with others without prior permission.Faculty/School
Faculty of Medicine and Health, Northern Clinical SchoolAwarding institution
The University of SydneyShare