Comparative Effectiveness of Cognitive Behavioral Therapy for Chronic Pain and Chronic Pain Self-Management within the Context of Voluntary Patient-Centered Prescription Opioid Tapering: The EMPOWER Study Protocol.
Identifieur interne : 000022 ( Main/Exploration ); précédent : 000021; suivant : 000023Comparative Effectiveness of Cognitive Behavioral Therapy for Chronic Pain and Chronic Pain Self-Management within the Context of Voluntary Patient-Centered Prescription Opioid Tapering: The EMPOWER Study Protocol.
Auteurs : Beth D. Darnall [États-Unis] ; Sean C. Mackey [États-Unis] ; Kate Lorig [États-Unis] ; Ming-Chih Kao [États-Unis] ; Aram Mardian [États-Unis] ; Richard Stieg ; Joel Porter [États-Unis] ; Korina Debruyne [États-Unis] ; Jennifer Murphy [États-Unis] ; Luzmercy Perez [États-Unis] ; Heather Okvat [États-Unis] ; Lu Tian [États-Unis] ; Pamela Flood [États-Unis] ; Mark Mcgovern [États-Unis] ; Luana Colloca [États-Unis] ; Heather King [États-Unis] ; Brent Van Dorsten [États-Unis] ; Ting Pun ; Matthias Cheung [États-Unis]Source :
- Pain medicine (Malden, Mass.) [ 1526-4637 ] ; 2020.
Abstract
OBJECTIVE
Evidence to date, while sparse, suggests that patients taking long-term opioids require special considerations and protections to prevent potential iatrogenic harms from opioid de-prescribing, such as increased pain or suffering. Following this study protocol, the EMPOWER study seeks to address multiple unmet needs of patients with chronic pain who desire to reduce long-term opioid therapy, and provide the clinical evidence on effective methodology.
METHODS
EMPOWER applies patient-centered methods for voluntary prescription opioid reduction conducted within a comprehensive, multi-state, 3-arm randomized controlled comparative effectiveness study of three study arms (1) group cognitive behavioral therapy for chronic pain; (2) group chronic pain self-management; and (3) usual care (taper only). Specialized electronic data capture systems collect patient reported symptoms and satisfaction data weekly and monthly during the taper, with real-time clinical alerts and electronic feedback loops informing, documenting, and steering needed care actions.
CONCLUSION
The EMPOWER study seeks to provide granular evidence on patient response to voluntary opioid tapering, and will provide evidence to inform clinical systems changes, clinical care, patient satisfaction, and patient outcomes for opioid reduction.
DOI: 10.1093/pm/pnz285
PubMed: 31876947
PubMed Central: PMC7530567
Affiliations:
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Mackey</name><affiliation wicri:level="2"><nlm:affiliation>Division of Pain Medicine, Stanford Systems Neuroscience and Pain Lab, Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Palo Alto, California.</nlm:affiliation><country>États-Unis</country><placeName><region type="state">Californie</region></placeName><wicri:cityArea>Division of Pain Medicine, Stanford Systems Neuroscience and Pain Lab, Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Palo Alto</wicri:cityArea></affiliation></author><author><name sortKey="Lorig, Kate" sort="Lorig, Kate" uniqKey="Lorig K" first="Kate" last="Lorig">Kate Lorig</name><affiliation wicri:level="2"><nlm:affiliation>Stanford University School of Medicine, Palo Alto, California.</nlm:affiliation><country>États-Unis</country><placeName><region type="state">Californie</region></placeName><wicri:cityArea>Stanford University School of Medicine, Palo Alto</wicri:cityArea></affiliation></author><author><name sortKey="Kao, Ming Chih" sort="Kao, Ming Chih" uniqKey="Kao M" first="Ming-Chih" last="Kao">Ming-Chih Kao</name><affiliation wicri:level="2"><nlm:affiliation>Division of Pain Medicine, Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Palo Alto, California.</nlm:affiliation><country>États-Unis</country><placeName><region type="state">Californie</region></placeName><wicri:cityArea>Division of Pain Medicine, Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Palo Alto</wicri:cityArea></affiliation></author><author><name sortKey="Mardian, Aram" sort="Mardian, Aram" uniqKey="Mardian A" first="Aram" last="Mardian">Aram Mardian</name><affiliation wicri:level="2"><nlm:affiliation>Department of Family, Community, and Preventive Medicine, Phoenix VA Health Care System, Chronic Pain Wellness Center, University of Arizona College of Medicine-Phoenix, Phoenix, Arizona.</nlm:affiliation><country xml:lang="fr">États-Unis</country><placeName><region type="state">Arizona</region></placeName><wicri:cityArea>Department of Family, Community, and Preventive Medicine, Phoenix VA Health Care System, Chronic Pain Wellness Center, University of Arizona College of Medicine-Phoenix, Phoenix</wicri:cityArea></affiliation></author><author><name sortKey="Stieg, Richard" sort="Stieg, Richard" uniqKey="Stieg R" first="Richard" last="Stieg">Richard Stieg</name></author><author><name sortKey="Porter, Joel" sort="Porter, Joel" uniqKey="Porter J" first="Joel" last="Porter">Joel Porter</name><affiliation wicri:level="2"><nlm:affiliation>Department of Family Medicine, Intermountain Healthcare, Layton, Utah.</nlm:affiliation><country xml:lang="fr">États-Unis</country><placeName><region type="state">Utah</region></placeName><wicri:cityArea>Department of Family Medicine, Intermountain Healthcare, Layton</wicri:cityArea></affiliation></author><author><name sortKey="Debruyne, Korina" sort="Debruyne, Korina" uniqKey="Debruyne K" first="Korina" last="Debruyne">Korina Debruyne</name><affiliation wicri:level="2"><nlm:affiliation>Division of Primary, Preventive and, Community Care, Stanford School of Medicine, Stanford University School of Medicine, Palo Alto, California.</nlm:affiliation><country>États-Unis</country><placeName><region type="state">Californie</region></placeName><wicri:cityArea>Division of Primary, Preventive and, Community Care, Stanford School of Medicine, Stanford University School of Medicine, Palo Alto</wicri:cityArea></affiliation></author><author><name sortKey="Murphy, Jennifer" sort="Murphy, Jennifer" uniqKey="Murphy J" first="Jennifer" last="Murphy">Jennifer Murphy</name><affiliation wicri:level="2"><nlm:affiliation>James A. Haley Veterans' Hospital, University of South Florida School of Medicine, Tampa, Florida.</nlm:affiliation><country xml:lang="fr">États-Unis</country><placeName><region type="state">Floride</region></placeName><wicri:cityArea>James A. Haley Veterans' Hospital, University of South Florida School of Medicine, Tampa</wicri:cityArea></affiliation></author><author><name sortKey="Perez, Luzmercy" sort="Perez, Luzmercy" uniqKey="Perez L" first="Luzmercy" last="Perez">Luzmercy Perez</name><affiliation wicri:level="2"><nlm:affiliation>Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Palo Alto, California.</nlm:affiliation><country>États-Unis</country><placeName><region type="state">Californie</region></placeName><wicri:cityArea>Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Palo Alto</wicri:cityArea></affiliation></author><author><name sortKey="Okvat, Heather" sort="Okvat, Heather" uniqKey="Okvat H" first="Heather" last="Okvat">Heather Okvat</name><affiliation wicri:level="2"><nlm:affiliation>Department of Family, Community, and Preventive Medicine, Phoenix VA Health Care System, Chronic Pain Wellness Center, University of Arizona College of Medicine-Phoenix, Phoenix, Arizona.</nlm:affiliation><country xml:lang="fr">États-Unis</country><placeName><region type="state">Arizona</region></placeName><wicri:cityArea>Department of Family, Community, and Preventive Medicine, Phoenix VA Health Care System, Chronic Pain Wellness Center, University of Arizona College of Medicine-Phoenix, Phoenix</wicri:cityArea></affiliation></author><author><name sortKey="Tian, Lu" sort="Tian, Lu" uniqKey="Tian L" first="Lu" last="Tian">Lu Tian</name><affiliation wicri:level="2"><nlm:affiliation>Stanford University School of Medicine, Palo Alto, California.</nlm:affiliation><country>États-Unis</country><placeName><region type="state">Californie</region></placeName><wicri:cityArea>Stanford University School of Medicine, Palo Alto</wicri:cityArea></affiliation></author><author><name sortKey="Flood, Pamela" sort="Flood, Pamela" uniqKey="Flood P" first="Pamela" last="Flood">Pamela Flood</name><affiliation wicri:level="2"><nlm:affiliation>Division of Pain Medicine, Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Palo Alto, California.</nlm:affiliation><country>États-Unis</country><placeName><region type="state">Californie</region></placeName><wicri:cityArea>Division of Pain Medicine, Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Palo Alto</wicri:cityArea></affiliation></author><author><name sortKey="Mcgovern, Mark" sort="Mcgovern, Mark" uniqKey="Mcgovern M" first="Mark" last="Mcgovern">Mark Mcgovern</name><affiliation wicri:level="2"><nlm:affiliation>Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Palo Alto, California.</nlm:affiliation><country>États-Unis</country><placeName><region type="state">Californie</region></placeName><wicri:cityArea>Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Palo Alto</wicri:cityArea></affiliation></author><author><name sortKey="Colloca, Luana" sort="Colloca, Luana" uniqKey="Colloca L" first="Luana" last="Colloca">Luana Colloca</name><affiliation wicri:level="2"><nlm:affiliation>University of Maryland School of Nursing, University of Maryland School of Medicine, Baltimore, Maryland.</nlm:affiliation><country xml:lang="fr">États-Unis</country><placeName><region type="state">Maryland</region></placeName><wicri:cityArea>University of Maryland School of Nursing, University of Maryland School of Medicine, Baltimore</wicri:cityArea></affiliation></author><author><name sortKey="King, Heather" sort="King, Heather" uniqKey="King H" first="Heather" last="King">Heather King</name><affiliation wicri:level="2"><nlm:affiliation>Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Palo Alto, California.</nlm:affiliation><country>États-Unis</country><placeName><region type="state">Californie</region></placeName><wicri:cityArea>Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Palo Alto</wicri:cityArea></affiliation></author><author><name sortKey="Van Dorsten, Brent" sort="Van Dorsten, Brent" uniqKey="Van Dorsten B" first="Brent" last="Van Dorsten">Brent Van Dorsten</name><affiliation wicri:level="2"><nlm:affiliation>Colorado Center for Behavioral Medicine, Denver, Colorado.</nlm:affiliation><country xml:lang="fr">États-Unis</country><placeName><region type="state">Colorado</region></placeName><wicri:cityArea>Colorado Center for Behavioral Medicine, Denver</wicri:cityArea></affiliation></author><author><name sortKey="Pun, Ting" sort="Pun, Ting" uniqKey="Pun T" first="Ting" last="Pun">Ting Pun</name></author><author><name sortKey="Cheung, Matthias" sort="Cheung, Matthias" uniqKey="Cheung M" first="Matthias" last="Cheung">Matthias Cheung</name><affiliation wicri:level="2"><nlm:affiliation>Thomas J. Long School of Pharmacy, University of the Pacific, Stockton, California, USA.</nlm:affiliation><country xml:lang="fr">États-Unis</country><wicri:regionArea>Thomas J. Long School of Pharmacy, University of the Pacific, Stockton, California</wicri:regionArea><placeName><region type="state">Californie</region></placeName></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">PubMed</idno><date when="2020">2020</date><idno type="RBID">pubmed:31876947</idno><idno type="pmid">31876947</idno><idno type="doi">10.1093/pm/pnz285</idno><idno type="pmc">PMC7530567</idno><idno type="wicri:Area/Main/Corpus">000023</idno><idno type="wicri:explorRef" wicri:stream="Main" wicri:step="Corpus" wicri:corpus="PubMed">000023</idno><idno type="wicri:Area/Main/Curation">000023</idno><idno type="wicri:explorRef" wicri:stream="Main" wicri:step="Curation">000023</idno><idno type="wicri:Area/Main/Exploration">000023</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en">Comparative Effectiveness of Cognitive Behavioral Therapy for Chronic Pain and Chronic Pain Self-Management within the Context of Voluntary Patient-Centered Prescription Opioid Tapering: The EMPOWER Study Protocol.</title><author><name sortKey="Darnall, Beth D" sort="Darnall, Beth D" uniqKey="Darnall B" first="Beth D" last="Darnall">Beth D. Darnall</name><affiliation wicri:level="2"><nlm:affiliation>Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Palo Alto, California.</nlm:affiliation><country>États-Unis</country><placeName><region type="state">Californie</region></placeName><wicri:cityArea>Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Palo Alto</wicri:cityArea></affiliation></author><author><name sortKey="Mackey, Sean C" sort="Mackey, Sean C" uniqKey="Mackey S" first="Sean C" last="Mackey">Sean C. Mackey</name><affiliation wicri:level="2"><nlm:affiliation>Division of Pain Medicine, Stanford Systems Neuroscience and Pain Lab, Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Palo Alto, California.</nlm:affiliation><country>États-Unis</country><placeName><region type="state">Californie</region></placeName><wicri:cityArea>Division of Pain Medicine, Stanford Systems Neuroscience and Pain Lab, Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Palo Alto</wicri:cityArea></affiliation></author><author><name sortKey="Lorig, Kate" sort="Lorig, Kate" uniqKey="Lorig K" first="Kate" last="Lorig">Kate Lorig</name><affiliation wicri:level="2"><nlm:affiliation>Stanford University School of Medicine, Palo Alto, California.</nlm:affiliation><country>États-Unis</country><placeName><region type="state">Californie</region></placeName><wicri:cityArea>Stanford University School of Medicine, Palo Alto</wicri:cityArea></affiliation></author><author><name sortKey="Kao, Ming Chih" sort="Kao, Ming Chih" uniqKey="Kao M" first="Ming-Chih" last="Kao">Ming-Chih Kao</name><affiliation wicri:level="2"><nlm:affiliation>Division of Pain Medicine, Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Palo Alto, California.</nlm:affiliation><country>États-Unis</country><placeName><region type="state">Californie</region></placeName><wicri:cityArea>Division of Pain Medicine, Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Palo Alto</wicri:cityArea></affiliation></author><author><name sortKey="Mardian, Aram" sort="Mardian, Aram" uniqKey="Mardian A" first="Aram" last="Mardian">Aram Mardian</name><affiliation wicri:level="2"><nlm:affiliation>Department of Family, Community, and Preventive Medicine, Phoenix VA Health Care System, Chronic Pain Wellness Center, University of Arizona College of Medicine-Phoenix, Phoenix, Arizona.</nlm:affiliation><country xml:lang="fr">États-Unis</country><placeName><region type="state">Arizona</region></placeName><wicri:cityArea>Department of Family, Community, and Preventive Medicine, Phoenix VA Health Care System, Chronic Pain Wellness Center, University of Arizona College of Medicine-Phoenix, Phoenix</wicri:cityArea></affiliation></author><author><name sortKey="Stieg, Richard" sort="Stieg, Richard" uniqKey="Stieg R" first="Richard" last="Stieg">Richard Stieg</name></author><author><name sortKey="Porter, Joel" sort="Porter, Joel" uniqKey="Porter J" first="Joel" last="Porter">Joel Porter</name><affiliation wicri:level="2"><nlm:affiliation>Department of Family Medicine, Intermountain Healthcare, Layton, Utah.</nlm:affiliation><country xml:lang="fr">États-Unis</country><placeName><region type="state">Utah</region></placeName><wicri:cityArea>Department of Family Medicine, Intermountain Healthcare, Layton</wicri:cityArea></affiliation></author><author><name sortKey="Debruyne, Korina" sort="Debruyne, Korina" uniqKey="Debruyne K" first="Korina" last="Debruyne">Korina Debruyne</name><affiliation wicri:level="2"><nlm:affiliation>Division of Primary, Preventive and, Community Care, Stanford School of Medicine, Stanford University School of Medicine, Palo Alto, California.</nlm:affiliation><country>États-Unis</country><placeName><region type="state">Californie</region></placeName><wicri:cityArea>Division of Primary, Preventive and, Community Care, Stanford School of Medicine, Stanford University School of Medicine, Palo Alto</wicri:cityArea></affiliation></author><author><name sortKey="Murphy, Jennifer" sort="Murphy, Jennifer" uniqKey="Murphy J" first="Jennifer" last="Murphy">Jennifer Murphy</name><affiliation wicri:level="2"><nlm:affiliation>James A. Haley Veterans' Hospital, University of South Florida School of Medicine, Tampa, Florida.</nlm:affiliation><country xml:lang="fr">États-Unis</country><placeName><region type="state">Floride</region></placeName><wicri:cityArea>James A. Haley Veterans' Hospital, University of South Florida School of Medicine, Tampa</wicri:cityArea></affiliation></author><author><name sortKey="Perez, Luzmercy" sort="Perez, Luzmercy" uniqKey="Perez L" first="Luzmercy" last="Perez">Luzmercy Perez</name><affiliation wicri:level="2"><nlm:affiliation>Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Palo Alto, California.</nlm:affiliation><country>États-Unis</country><placeName><region type="state">Californie</region></placeName><wicri:cityArea>Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Palo Alto</wicri:cityArea></affiliation></author><author><name sortKey="Okvat, Heather" sort="Okvat, Heather" uniqKey="Okvat H" first="Heather" last="Okvat">Heather Okvat</name><affiliation wicri:level="2"><nlm:affiliation>Department of Family, Community, and Preventive Medicine, Phoenix VA Health Care System, Chronic Pain Wellness Center, University of Arizona College of Medicine-Phoenix, Phoenix, Arizona.</nlm:affiliation><country xml:lang="fr">États-Unis</country><placeName><region type="state">Arizona</region></placeName><wicri:cityArea>Department of Family, Community, and Preventive Medicine, Phoenix VA Health Care System, Chronic Pain Wellness Center, University of Arizona College of Medicine-Phoenix, Phoenix</wicri:cityArea></affiliation></author><author><name sortKey="Tian, Lu" sort="Tian, Lu" uniqKey="Tian L" first="Lu" last="Tian">Lu Tian</name><affiliation wicri:level="2"><nlm:affiliation>Stanford University School of Medicine, Palo Alto, California.</nlm:affiliation><country>États-Unis</country><placeName><region type="state">Californie</region></placeName><wicri:cityArea>Stanford University School of Medicine, Palo Alto</wicri:cityArea></affiliation></author><author><name sortKey="Flood, Pamela" sort="Flood, Pamela" uniqKey="Flood P" first="Pamela" last="Flood">Pamela Flood</name><affiliation wicri:level="2"><nlm:affiliation>Division of Pain Medicine, Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Palo Alto, California.</nlm:affiliation><country>États-Unis</country><placeName><region type="state">Californie</region></placeName><wicri:cityArea>Division of Pain Medicine, Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Palo Alto</wicri:cityArea></affiliation></author><author><name sortKey="Mcgovern, Mark" sort="Mcgovern, Mark" uniqKey="Mcgovern M" first="Mark" last="Mcgovern">Mark Mcgovern</name><affiliation wicri:level="2"><nlm:affiliation>Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Palo Alto, California.</nlm:affiliation><country>États-Unis</country><placeName><region type="state">Californie</region></placeName><wicri:cityArea>Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Palo Alto</wicri:cityArea></affiliation></author><author><name sortKey="Colloca, Luana" sort="Colloca, Luana" uniqKey="Colloca L" first="Luana" last="Colloca">Luana Colloca</name><affiliation wicri:level="2"><nlm:affiliation>University of Maryland School of Nursing, University of Maryland School of Medicine, Baltimore, Maryland.</nlm:affiliation><country xml:lang="fr">États-Unis</country><placeName><region type="state">Maryland</region></placeName><wicri:cityArea>University of Maryland School of Nursing, University of Maryland School of Medicine, Baltimore</wicri:cityArea></affiliation></author><author><name sortKey="King, Heather" sort="King, Heather" uniqKey="King H" first="Heather" last="King">Heather King</name><affiliation wicri:level="2"><nlm:affiliation>Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Palo Alto, California.</nlm:affiliation><country>États-Unis</country><placeName><region type="state">Californie</region></placeName><wicri:cityArea>Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Palo Alto</wicri:cityArea></affiliation></author><author><name sortKey="Van Dorsten, Brent" sort="Van Dorsten, Brent" uniqKey="Van Dorsten B" first="Brent" last="Van Dorsten">Brent Van Dorsten</name><affiliation wicri:level="2"><nlm:affiliation>Colorado Center for Behavioral Medicine, Denver, Colorado.</nlm:affiliation><country xml:lang="fr">États-Unis</country><placeName><region type="state">Colorado</region></placeName><wicri:cityArea>Colorado Center for Behavioral Medicine, Denver</wicri:cityArea></affiliation></author><author><name sortKey="Pun, Ting" sort="Pun, Ting" uniqKey="Pun T" first="Ting" last="Pun">Ting Pun</name></author><author><name sortKey="Cheung, Matthias" sort="Cheung, Matthias" uniqKey="Cheung M" first="Matthias" last="Cheung">Matthias Cheung</name><affiliation wicri:level="2"><nlm:affiliation>Thomas J. Long School of Pharmacy, University of the Pacific, Stockton, California, USA.</nlm:affiliation><country xml:lang="fr">États-Unis</country><wicri:regionArea>Thomas J. Long School of Pharmacy, University of the Pacific, Stockton, California</wicri:regionArea><placeName><region type="state">Californie</region></placeName></affiliation></author></analytic><series><title level="j">Pain medicine (Malden, Mass.)</title><idno type="eISSN">1526-4637</idno><imprint><date when="2020" type="published">2020</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><p><b>OBJECTIVE</b></p><p>Evidence to date, while sparse, suggests that patients taking long-term opioids require special considerations and protections to prevent potential iatrogenic harms from opioid de-prescribing, such as increased pain or suffering. Following this study protocol, the EMPOWER study seeks to address multiple unmet needs of patients with chronic pain who desire to reduce long-term opioid therapy, and provide the clinical evidence on effective methodology.</p></div><div type="abstract" xml:lang="en"><p><b>METHODS</b></p><p>EMPOWER applies patient-centered methods for voluntary prescription opioid reduction conducted within a comprehensive, multi-state, 3-arm randomized controlled comparative effectiveness study of three study arms (1) group cognitive behavioral therapy for chronic pain; (2) group chronic pain self-management; and (3) usual care (taper only). Specialized electronic data capture systems collect patient reported symptoms and satisfaction data weekly and monthly during the taper, with real-time clinical alerts and electronic feedback loops informing, documenting, and steering needed care actions.</p></div><div type="abstract" xml:lang="en"><p><b>CONCLUSION</b></p><p>The EMPOWER study seeks to provide granular evidence on patient response to voluntary opioid tapering, and will provide evidence to inform clinical systems changes, clinical care, patient satisfaction, and patient outcomes for opioid reduction.</p></div></front></TEI><pubmed><MedlineCitation Status="In-Process" Owner="NLM"><PMID Version="1">31876947</PMID><DateRevised><Year>2020</Year><Month>10</Month><Day>09</Day></DateRevised><Article PubModel="Print"><Journal><ISSN IssnType="Electronic">1526-4637</ISSN><JournalIssue CitedMedium="Internet"><Volume>21</Volume><Issue>8</Issue><PubDate><Year>2020</Year><Month>08</Month><Day>01</Day></PubDate></JournalIssue><Title>Pain medicine (Malden, Mass.)</Title><ISOAbbreviation>Pain Med</ISOAbbreviation></Journal><ArticleTitle>Comparative Effectiveness of Cognitive Behavioral Therapy for Chronic Pain and Chronic Pain Self-Management within the Context of Voluntary Patient-Centered Prescription Opioid Tapering: The EMPOWER Study Protocol.</ArticleTitle><Pagination><MedlinePgn>1523-1531</MedlinePgn></Pagination><ELocationID EIdType="doi" ValidYN="Y">10.1093/pm/pnz285</ELocationID><Abstract><AbstractText Label="OBJECTIVE">Evidence to date, while sparse, suggests that patients taking long-term opioids require special considerations and protections to prevent potential iatrogenic harms from opioid de-prescribing, such as increased pain or suffering. Following this study protocol, the EMPOWER study seeks to address multiple unmet needs of patients with chronic pain who desire to reduce long-term opioid therapy, and provide the clinical evidence on effective methodology.</AbstractText><AbstractText Label="METHODS">EMPOWER applies patient-centered methods for voluntary prescription opioid reduction conducted within a comprehensive, multi-state, 3-arm randomized controlled comparative effectiveness study of three study arms (1) group cognitive behavioral therapy for chronic pain; (2) group chronic pain self-management; and (3) usual care (taper only). Specialized electronic data capture systems collect patient reported symptoms and satisfaction data weekly and monthly during the taper, with real-time clinical alerts and electronic feedback loops informing, documenting, and steering needed care actions.</AbstractText><AbstractText Label="CONCLUSION">The EMPOWER study seeks to provide granular evidence on patient response to voluntary opioid tapering, and will provide evidence to inform clinical systems changes, clinical care, patient satisfaction, and patient outcomes for opioid reduction.</AbstractText><CopyrightInformation>© 2019 American Academy of Pain Medicine.</CopyrightInformation></Abstract><AuthorList CompleteYN="Y"><Author ValidYN="Y"><LastName>Darnall</LastName><ForeName>Beth D</ForeName><Initials>BD</Initials><AffiliationInfo><Affiliation>Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Palo Alto, California.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Mackey</LastName><ForeName>Sean C</ForeName><Initials>SC</Initials><AffiliationInfo><Affiliation>Division of Pain Medicine, Stanford Systems Neuroscience and Pain Lab, Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Palo Alto, California.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Lorig</LastName><ForeName>Kate</ForeName><Initials>K</Initials><AffiliationInfo><Affiliation>Stanford University School of Medicine, Palo Alto, California.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Kao</LastName><ForeName>Ming-Chih</ForeName><Initials>MC</Initials><AffiliationInfo><Affiliation>Division of Pain Medicine, Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Palo Alto, California.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Mardian</LastName><ForeName>Aram</ForeName><Initials>A</Initials><AffiliationInfo><Affiliation>Department of Family, Community, and Preventive Medicine, Phoenix VA Health Care System, Chronic Pain Wellness Center, University of Arizona College of Medicine-Phoenix, Phoenix, Arizona.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Stieg</LastName><ForeName>Richard</ForeName><Initials>R</Initials></Author><Author ValidYN="Y"><LastName>Porter</LastName><ForeName>Joel</ForeName><Initials>J</Initials><AffiliationInfo><Affiliation>Department of Family Medicine, Intermountain Healthcare, Layton, Utah.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>DeBruyne</LastName><ForeName>Korina</ForeName><Initials>K</Initials><AffiliationInfo><Affiliation>Division of Primary, Preventive and, Community Care, Stanford School of Medicine, Stanford University School of Medicine, Palo Alto, California.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Murphy</LastName><ForeName>Jennifer</ForeName><Initials>J</Initials><AffiliationInfo><Affiliation>James A. Haley Veterans' Hospital, University of South Florida School of Medicine, Tampa, Florida.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Perez</LastName><ForeName>Luzmercy</ForeName><Initials>L</Initials><AffiliationInfo><Affiliation>Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Palo Alto, California.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Okvat</LastName><ForeName>Heather</ForeName><Initials>H</Initials><AffiliationInfo><Affiliation>Department of Family, Community, and Preventive Medicine, Phoenix VA Health Care System, Chronic Pain Wellness Center, University of Arizona College of Medicine-Phoenix, Phoenix, Arizona.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Tian</LastName><ForeName>Lu</ForeName><Initials>L</Initials><AffiliationInfo><Affiliation>Stanford University School of Medicine, Palo Alto, California.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Flood</LastName><ForeName>Pamela</ForeName><Initials>P</Initials><AffiliationInfo><Affiliation>Division of Pain Medicine, Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Palo Alto, California.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>McGovern</LastName><ForeName>Mark</ForeName><Initials>M</Initials><AffiliationInfo><Affiliation>Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Palo Alto, California.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Colloca</LastName><ForeName>Luana</ForeName><Initials>L</Initials><AffiliationInfo><Affiliation>University of Maryland School of Nursing, University of Maryland School of Medicine, Baltimore, Maryland.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>King</LastName><ForeName>Heather</ForeName><Initials>H</Initials><AffiliationInfo><Affiliation>Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Palo Alto, California.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Van Dorsten</LastName><ForeName>Brent</ForeName><Initials>B</Initials><AffiliationInfo><Affiliation>Colorado Center for Behavioral Medicine, Denver, Colorado.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Pun</LastName><ForeName>Ting</ForeName><Initials>T</Initials></Author><Author ValidYN="Y"><LastName>Cheung</LastName><ForeName>Matthias</ForeName><Initials>M</Initials><AffiliationInfo><Affiliation>Thomas J. Long School of Pharmacy, University of the Pacific, Stockton, California, USA.</Affiliation></AffiliationInfo></Author></AuthorList><Language>eng</Language><PublicationTypeList><PublicationType UI="D016428">Journal Article</PublicationType><PublicationType UI="D013485">Research Support, Non-U.S. Gov't</PublicationType></PublicationTypeList></Article><MedlineJournalInfo><Country>England</Country><MedlineTA>Pain Med</MedlineTA><NlmUniqueID>100894201</NlmUniqueID><ISSNLinking>1526-2375</ISSNLinking></MedlineJournalInfo><CitationSubset>IM</CitationSubset><KeywordList Owner="NOTNLM"><Keyword MajorTopicYN="Y">CHOIR</Keyword><Keyword MajorTopicYN="Y">EMPOWER</Keyword><Keyword MajorTopicYN="Y">Opioids</Keyword><Keyword MajorTopicYN="Y">chronic pain</Keyword><Keyword MajorTopicYN="Y">taper</Keyword></KeywordList></MedlineCitation><PubmedData><History><PubMedPubDate PubStatus="pubmed"><Year>2019</Year><Month>12</Month><Day>27</Day><Hour>6</Hour><Minute>0</Minute></PubMedPubDate><PubMedPubDate 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first="Beth D" last="Darnall">Beth D. 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