March 5, 2020: NOHARM to Test EHR-Embedded Clinical Decision Support for Postoperative Pain Care: An Interview With Dr. Andrea Cheville

Prescriptions for narcotic pain relief after surgery often lead to unintended prolonged opioid use. Nonpharmacologic approaches are effective and are recommended by clinical guidelines for postoperative pain but are rarely used as first-line or second-line therapy.

The Nonpharmacologic Options in Postoperative Hospital-based and Rehabilitation Pain Management (NOHARM) pragmatic trial, a new NIH Collaboratory Demonstration Project, will test a clinical decision support tool embedded in the electronic health record in 4 healthcare systems. We spoke with co–principal investigator Dr. Andrea Cheville about NOHARM at the NIH Collaboratory PRISM kickoff meeting in November.

“There are millions of surgeries performed every year in the United States, and many patients experience significant pain and loss of function afterwards,” explained Dr. Cheville. “Our hope is to introduce and increase the reliance on nonpharmacologic pain care, which is very safe and as or more effective than most of our medical pain-relieving strategies…to make that a more consistent and credible option for our patients and our clinicians,” she said.

Clinical decision support tools embedded in the electronic health record can be useful in encouraging patient-centered, guideline concordant care, but pragmatic strategies have not been tested pragmatically in postoperative pain care.

“We’re trying to target many, many points along well-established workflow. It would be very challenging in a conventional clinical trial paradigm to really test an intervention,” said Dr. Cheville.

The NOHARM trial is a project of the PRISM program (Pragmatic and Implementation Studies for the Management of Pain to Reduce Opioid Prescribing), part of the NIH’s Helping to End Addiction Long-term (HEAL) Initiative. The NIH Collaboratory serves as the PRISM Resource Coordinating Center.

Dr. Cheville reflected on the exciting opportunity to participate the Collaboratory. “We are very excited to bring our novel use of the electronic health record as a critical and central intervention component and to bring that approach to the Collaboratory so we can both teach and learn as we move forward in this trial,” she said.

NOHARM is supported by the National Institute on Aging. The NIH Collaboratory PRISM Resource Coordinating Center is supported by the National Center for Complementary and Integrative Medicine. Support is also provided by the NIH Common Fund through a cooperative agreement from the Office of Strategic Coordination within the Office of the NIH Director.