Development of the Building Efficacy for Successful Tapering BEST Program

ABSTRACT Over million Americans suffer from chronic pain The use of chronic opioid therapy COT for pain has increased dramatically as have reports of opioid misuse abuse dangerous interactions with other drugs overdose and death As concerns over the alarming effects of COT have risen regulatory efforts have increased as well including medically supervised opioid tapering Tapering can be daunting to many patients who lack the self efficacy and pain management skills to successfully navigate the process According to Bandura self efficacy refers to the belief that one can successfully perform the necessary actions to achieve a desired outcome in a given situation e g tapering The proposed Phase I SBIR project will include the preliminary development and pilot testing of the online Building Efficacy for Successful Tapering BEST program The BEST Program is a practical application of pain self management principles specifically targeting the tapering process BEST is designed to enhance self efficacy for tapering by training the patient to systematically sample and test a variety of evidence based non opioid pain management strategies in order to develop a repertoire of personally vetted techniques Patients will learn evidence based strategies pain reducers derived from cognitive behavioral motivational and interpersonal models of pain self management including emotion focused behavioral cognitive and attentional techniques Program participants will identify and systematically test and track their custom list of pain reducers from these categories A reporting function will help patients to visualize progress gain insight into their most beneficial strategies and build performance based self efficacy Moreover as the patient enters data into the BEST program over time the system will be capable of using those data to offer custom recommendations If found effective the BEST Program will fill a significant gap in chronic pain treatment by helping patients to confidently transition from the use of opioids avoid the pitfalls of misuse abuse and heighten the acceptability of alternative treatments The Phase I project will include content development web design and software development formative evaluation usability testing and revision N patients undergoing medically supervised opioid tapering and a pilot randomized controlled trial N patients undergoing opioid tapering randomly assigned to the BEST Program or to Usual Care The RCT will provide preliminary estimates of effect sizes for program related changes in pain self efficacy intensity interference and self report of opioid misuse and evidence of program acceptability Successful results would lay the groundwork for Phase II which would involve the addition of several Program enhancements including a mobile version a clinician portal to monitor patient progress and additional tracking features A full scale RCT would be conducted in Phase II to examine efficacy for a broader range of outcomes in a large sample over an extended follow up period PROJECT NARRATIVE The long term goal of the proposed project is the development and testing of the effectiveness of the Building Efficacy for Successful Tapering BEST Program The aim of the web based BEST Program is to instill self efficacy for successful tapering by helping the patient to systematically sample and test a variety of non opioid pain management techniques so as to build a repertoire of personally vetted strategies If found effective the BEST Program will fill a critical void in chronic pain treatment by helping patients to confidently transition from the use of opioids avoid the pitfalls of misuse abuse and heighten the acceptability of alternative treatments The BEST Program has the potential to provide scientifically sound information to large numbers of individuals at low cost