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 test an EHR-embedded, bundled intervention comprised of patient- and clinician-facing decision support components that enable patients to integrate nonpharmacologic pain care into their perioperative management. NOHARM will employ a stepped-wedge, cluster randomized pragmatic clinical trial design. Clusters throughout the Mayo Clinic Enterprise spanning 6 institutions in 4 states will participate. The NOHARM trial will evaluate whether pain and function, assessed with PROMIS tools, can be improved while honoring patient values and deemphasizing opioids in pain management.

NIH Project Information