Speakers

Andrea Cheville, MD
Physiatrist
Mayo Clinic

Jon Tilburt, MD
Internist
Mayo Clinic

Keywords

Nonpharmacologic Pain Care; Pain; Peri-operative; Surgery; Opioid Use

Slides

Key Points

• Nonpharmacologic pain care (NPPC) is effective across numerous conditions; has low toxicity and few adverse effects; addresses pain and co-occurring symptoms; and is often inexpensive and accessible. However, it can be difficult to implement given barriers like limited clinician time, skepticism, heterogeneous patient preferences, and the need for reinforcement over time.

• NOHARM is an NIH Collaboratory trial examining how health systems can deliver guideline-concordant NPPC at a population scale. 60,000 surgical patients were enrolled across 6 campuses. The study team’s goals were to support patient education and decision-making around options for NPPC and to support patients in their pursuit of NPPC modalities, not to deny patients access to necessary or helpful opioids or other pharmacologic options.

• Roughly 1/3 of participants received usual care while roughly 2/3 received a bundled pain education and decision support intervention promoting NPPC use, including a portal-based conversation guide; electronic health record clinical decision support; enhanced patient education; and non-pharmacological pain self-management materials. The primary outcomes were pain interference and physical function.

• The researchers found no statistically significant impact on the co-primary outcomes. There was, however, a 10% reduction in overall 3-month post-operative opioid consumption, with no increase in adverse events or fall risks.

• NOHARM is a scalable primary prevention strategy that can reduce exposure, make stewardship part of routine care, and reach surgical populations alongside more intensive perioperative pathways and programs.

Discussion Themes

Challenges included low-touch patient engagement, pandemic-driven nursing staff turnover, and the ongoing technical and organizational effort required to sustain EHR functionality post-trial.

A secondary sensitivity analysis supported non-inferiority for the primary pain and function outcomes. Attendees noted a positive clinical interpretation: patients in the intervention group achieved equivalent pain control while requiring significantly lower opioid doses.

Targeting bedside nurses and occupational or physical therapists—rather than prescribing physicians—was key to supporting patients during acute pain episodes.