The development and piloting of a mobile health (mHealth) intervention to support patients with chronic pain to taper prescription opioid medications

Abstract

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: 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.