Trial Summary

Prescriptions for narcotic pain relief after surgery result in unintended prolonged opioid use for hundreds of thousands of Americans. That trend fuels an excess supply of opioids that can lead to dependence, addiction, diversion, and overdoses on a national scale. Nonpharmacologic pain care is effective and recommended by guidelines for perioperative pain while offering a more favorable risk benefit ratio. However, nonpharmacologic pain care is rarely used as first- or second-line therapy after surgery. Patient and clinician decision support interventions are effective in encouraging patient-centered and guideline-concordant care, but these strategies have not been tested pragmatically as a bundle in everyday postoperative pain care.

The NOHARM trial will first confirm the feasibility of patient-facing as well as clinician-facing decision support components of an EHR-embedded evidence-based bundle (Aim 1). This will then be tested in a stepped-wedge, cluster-randomized trial in four health systems (Aim 2) affiliated with a national healthcare organization that uses a common EHR platform. The study will test a sustainable system strategy that could change the paradigm of perioperative pain management toward nonpharmacologic options in a manner that preserves patient function, honors patient values, and maintains availability of opioids as a last resort. Results could serve as a model for healthcare organizations nationally and could be disseminated through our institution’s ongoing partnership with the largest national EHR vendor. To ensure our approach is sustainable, the study will evaluate at all study sites what worked and what did not (Aim 3), focusing on high-risk patients within a parent organization that has expressed a high-level commitment to addressing the opioid crisis.

NIH Project Information