Results from our newly published randomized controlled study show that patients who engaged with “My Surgical Success,” a fully automated online pain treatment program, stopped opioids sooner after breast cancer surgery than patients assigned to a control intervention. The study was published in Pain Medicine (Darnall et al, 2019).

This finding is important because it suggests that a low-cost, scalable, digital treatment may help patients effectively self-manage symptoms and enhance recovery after surgery. Our study is also the first to show that a digital pain medicine program reduces opioid use after surgery.

Importantly, patients were not directed to use less opioid medication after surgery. Rather, we assigned patients to treatment groups – one that included pain management skills—and observed how quickly patients stopped opioid use after surgery.

Behavioral medicine is broadly lacking in perioperative pathways. This represents a lost opportunity to provide patient education on how to best manage pain and distress after their surgery. Behavioral medicine can address pain as a multidimensional experience and engage patients as active participants in their surgical recovery.

The “My Surgical Success” digital behavioral medicine program was adapted from “Empowered Relief,” a single-session pain class that is the subject of an NIH-funded study for chronic low back pain treatment. The intervention content was tailored to surgical patients and digitized to make it online and available to any patient with internet access. The study was conducted in women receiving breast cancer surgery at Stanford Hospital.

Our first goal was to assess feasibility of “My Surgical Success” and answer the question: Will patients engage with an online intervention that is designed to help them have a better recovery after surgery?  Our second objective was to test group differences in post-surgical variables and how quickly patients stopped opioid use after surgery. A convenience sample of 131 adult women awaiting breast cancer surgery were enrolled, and 127 randomized to treatment group. The analytic sample was 68 patients (N=36 “My Surgical Success”, N=32 health education control).

Half of the patients assigned to “My Surgical Success” engaged in the treatment, thereby significantly exceeding the average patient engagement rates reported for other digital health interventions, such as smoking cessation. Keep in mind, there is no in-person contact with a therapist, and the intervention is free and available on-demand in the comfort of the patient’s home. The potential scale and reach of digital behavioral medicine is great, and could open new avenues of comprehensive perioperative pain care.

We found that “My Surgical Success” was associated with 86% increased odds of opioid cessation within the 12-week study period relative to patients assigned to general health education (hazard ratio 1.86 (95% CI: 1.12-3.10), p=0.016).

Patients who engaged with “My Surgical Success” stopped their opioids five days sooner than women assigned to the HE control. There were no significant differences in pre-post treatment pain or psychological variables between groups.

Currently, while there is a major national focus on reducing prescription opioids after surgery, it is important that we treat pain better and reduce patients’ need for opioids, rather than focusing on limiting opioids. Our study did not limit access to opioids for either group.

Key Points:

  • Findings suggest that a Stanford-developed perioperative digital behavioral pain medicine program may be a low-cost, accessible adjunct that could promote opioid cessation after breast cancer surgery.
  • “My Surgical Success” may enhance patient access to behavioral pain medicine in surgical patients.

Next Steps: Follow-up studies are currently underway at Stanford Hospital in collaboration with Michael Gardner, MD, in Orthopedic Trauma Surgery patients.

Full Citation: Darnall BD, Ziadni MS, Krishnamurthy P, Mackey IG, Heathcote L, Taub CJ, Flood P, Wheeler A. “My Surgical Success”: Impact of a digital behavioral pain medicine intervention on time to opioid cessation after breast cancer surgery (Pain Medicine, May 2019).

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