Postoperative PainPOINTNCT04710069
Postoperative Opt-In Narcotic Treatment Study
A study testing POINT in people with Postoperative Pain and Narcotic Use, run by University of California, Los Angeles at 1 site in United States.
Trial summary
pills go unused, generating waste and leaving an opportunity for misuse and abuse. In a recent study, researchers let patients choose what medications to go home with after surgery. After their thyroid or parathyroid surgery, 96% of patients declined narcotic pain medication. Read more about this study
- Who is it for?
- Ages 18 years and olderHealthy volunteers can take part
- Conditions the study is for
- Postoperative Pain, Narcotic Use, Analgesia
- What is being tested?
- POINT
- Type of treatment
- Lifestyle or therapy programme
- Could I receive a placebo?
- No, everyone receives an active treatment
- How many people
- 102 participants
- Where
- 1 siteUnited States
- Study dates
- 26 Jun 2020to 30 Jan 2021
- Phase
- Interventional
- Are there results?
- None posted in the registry
Key requirements
Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.
- Ages 18 years and older
- All sexes
- Healthy volunteers accepted
- Adult, Older adult
Who may be able to join
- Eligibility for outpatient parathyroidectomy, thyroidectomy or neck dissection Patients aged 18 or older English-speaking: Our provided materials (video instruction, written instructions, survey material) will be in English and we want to ensure clear communication with our study subjects. Once we have demonstrated feasibility of such an opt-in policy with our English-speaking subjects, we will expand our materials to additional languages.
Who cannot join
- Prior history of narcotic use Inpatient admission after surgery
Trial locations and contacts
1 site in 1 country.
About this study
Official title: Randomized Controlled Trial for Postoperative opt-in Narcotic Treatment in Outpatient Endocrine Surgery
pills go unused, generating waste and leaving an opportunity for misuse and abuse.
In a recent study, researchers let patients choose what medications to go home with after surgery. After their thyroid or parathyroid surgery, 96% of patients declined narcotic pain medication. They preferred to manage their pain with acetaminophen instead. Giving patients counseling and empowering them to choose significantly reduces the amount of opioids prescribed and wasted.
Read more
The aim of our study is to compare a similar "opt-in" protocol for narcotics to usual care (where patients are routinely discharged with opioids). We would elaborate upon the aforementioned study by studying patient pain scores on a more granular level once they return home.
Our study will be designed as a randomized, controlled trial. When adult patients consent for a thyroid or parathyroid surgery, they will be asked to participate in the study. Patients who are currently using narcotics would be excluded. We would then randomize participants to the "opt-in" protocol versus being provided with a standard opioid prescription after surgery. Patients in the opt-in protocol will be recommended a pain treatment regimen with over-the-counter medications, such as acetaminophen or ibuprofen. These patients will be reassured that if their pain is uncontrolled after discharge, a narcotic prescription will be called in to their pharmacy if requested.
We will assess patient pain scores and medication use in the recovery area using the electronic medical record. We will collect data on patient pain scores and medication use after discharge on a daily basis via phone call or electronically transmitted survey. We will also evaluate patients at the time of their follow-up visits. Any patient phone calls will be routed to study personnel who will fill narcotic prescription requests if requested. Finally, among patients who do receive an opioid prescription, we will track their opioid consumption.
Read the detailed description
Due to the current opioid epidemic, there has been increased focus on the prescribing patterns of physicians and greater incentive to reduce the amount of narcotic pain medication prescribed.
A prospective study was recently published in Annals of Surgery by Ruffolo et al. which described an opt-in narcotic treatment program for 216 patients who underwent outpatient endocrine cervical surgery (1). Patients were counseled in the pre-operative visit that after the surgery, they would be provided the option of narcotic pain medication versus over-the-counter medication. Prior to discharge, patients were evaluated by a member of the surgical team and offered a choice of postoperative pain medications. The study found only 4% of patients requested narcotic pain medication and achieved a 96.6% reduction in postoperative narcotic use. No patients called in to request narcotic pain medication after discharge.
The study participants were compared to a retrospective cohort of patients who were given narcotic medication postoperatively as the default option. There have been no randomized controlled trials comparing the two pain medication strategies in outpatient cervical endocrine surgery. Additionally, in that study, the level of postoperative pain was not fully assessed and quality of life measures were not studied.
In our institutional practice, having a member of the surgical team visit the patient at the bedside to assess pain level is not part of the standard postoperative work flow, given that the operative team is usually operating at the time the patient is discharged. In order to assess the feasibility of implementing such a program within our practice, we plan to develop alternative methods of presenting the decision for postoperative pain treatment in the immediate postoperative period that fits into our standard practice.
Significance:
Given the current health care and political climate, there has been increasing focus on reducing the amount of narcotics prescribed by health care providers. Based on the results of the above cited study, we believe implementing an opt-in program at UCLA will also significantly decrease the amount of opioids prescribed for postoperative pain. However, we will improve upon that study but assessing pain levels in the week immediately after surgery to ensure patients are not suffering from excessive pain levels at home without notifying providers, and compare these pain levels to patients who are randomized to standard postoperative care (automatically dispensed with a narcotic prescription). We will also assess quality of life measures after surgery to compare the impact of pain management strategy on the postoperative experience.
Ruffolo et al. demonstrated the feasibility in reducing the amount of narcotics prescribed by a significant level by initiating an opt-in program and empowering patients to make their own health care decisions. Incorporating this type of program into the standard operative work flow will maintain efficiency while working towards the goal of reducing narcotic usage. If we can demonstrate the feasibility of implementing such an opt-in program within the section of Endocrine Surgery, expanding the program to other divisions of ambulatory surgery in different surgical subspecialties may also be possible.
- Ruffolo LI, Jackson KM, Juviler P, et al. Narcotic Free Cervical Endocrine Surgery: A Shift in Paradigm. Ann Surg. 9000;Publish Ahead of Print.
- Conditions
- Postoperative Pain, Narcotic Use, Analgesia, Endocrine Surgery, Opioid Use, Opioid Abuse
- Being tested
- POINT
- Keywords
- Postoperative Pain, Narcotic Use, endocrine surgery
- Medical subject headings
- Pain, Postoperative, Agnosia, Opioid-Related Disorders
What participants receive
What participants receive. In a randomised study each person is assigned to one group by chance.
POINTBehavioural
Also called Opt-in
Patients randomized to the POINT program will be given preoperative counseling on adverse effects of opioids and expectations will be set that most patients do not require opioids for pain control after endocrine surgery, they will receive the info in writing afterwards as well. These patients will also be shown a short instructional video reiterating the counseling provided in the preoperative clinic visit. Information in the video will pertain to the expected pain after surgery, the over-the-counter options for pain control, the risks and side effects of using opioids, and reassurances that opioids may be prescribed at any time after discharge if pain is unmanageable. After the video, the patient will be provided with paperwork, requiring patient consent/signature to receive opioids if they opt into narcotic treatment. They will not be provided with a narcotic prescription if consent is not explicitly provided.
| Study group | Role | What they receive |
|---|---|---|
| Control/Usual Care | No intervention | standard treatment of postoperative pain, which involves automatic prescription of a narcotic pain medication regimen after surgery, |
| Opt-in/POINT | Experimental | An opt-in program (POINT), which requires the patient to consent to receiving a prescription for narcotics Receives: Behavioral: POINT |
What is being measured
The primary outcome is the main question the study is designed to answer.
Postoperative pain scores
Pain scores will be compared using regression analysis and t-tests.
Measured: Postoperative Day 0-7
oral morphine equivalents consumed
Possible predictors for narcotic use or higher pain scores will be assessed, including age, sex, type of surgery and preoperative questionnaire (PHQ-9) score using a mixed-effects model.
Measured: Postoperative Day 0-7
Secondary outcomes (1)
Postoperative Day 0-7
Possible predictors for narcotic use or higher pain scores will be assessed, including age, sex, type of surgery and preoperative questionnaire (PHQ-9) score using a mixed-effects model.
Measured: Postoperative Day 7
Timeline
From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.
- First posted14 Jan 2021
- Study start26 Jun 2020
- Primary completion30 Jan 2021
- Study completion30 Jan 2021
Resources
- Official record on ClinicalTrials.govThe registry entry this page is built from, with its full change history.
- Publications (2)Papers the sponsor has linked to this study.
- Other trials for Postoperative PainStudies of the same condition, open and under way.
- More trials run by University of California, Los AngelesThe sponsor's other registered studies.
- What the trial phases meanHow a treatment moves from first tests in people to approval.
More details
For doctors and researchers: how the study is designed, who runs it, and its registry IDs.
Study design
- Study type
- Interventional
- Phase
- Phase N/A
- Primary purpose
- Prevention
- Allocation
- Randomised
- Intervention model
- Parallel groups
- Masking
- Single blind
- Who is masked
- Care provider
- Enrolment
- 102 participants (actual)
Sponsor and investigators
- Lead sponsor
- University of California, Los Angeles
- Sponsor type
- University, hospital or other
- Responsible party
- Principal investigator, James Wu, MD, University of California, Los Angeles
- Investigators
- James Wu, MD, Principal investigator, University of California, Los AngelesMichael W Yeh, MD, Principal investigator, University of California, Los Angeles
IDs, dates and publications
- ClinicalTrials.gov ID
- NCT04710069
- Sponsor's protocol ID
- 19-001702
- Acronym
- POINT
- Status last verified
- Mar 2021
- First submitted
- 12 Jan 2021
- Last updated
- 4 Mar 2021
- Results posted
- No
- Data monitoring committee
- No
- FDA-regulated drug
- No
- FDA-regulated device
- No
- Individual data sharing
- No
Publications
Ruffolo LI, Jackson KM, Juviler P, Kaur R, Chennell T, Glover DM, Linehan DC, Moalem J. Narcotic Free Cervical Endocrine Surgery: A Shift in Paradigm. Ann Surg. 2021 Aug 1;274(2):e143-e149. doi: 10.1097/SLA.0000000000003443.
PubMed 31356280Zhu CY, Schumm MA, Hu TX, Nguyen DT, Kim J, Tseng CH, Lin AY, Yeh MW, Livhits MJ, Wu JX. Patient-Centered Decision-making for Postoperative Narcotic-Free Endocrine Surgery: A Randomized Clinical Trial. JAMA Surg. 2021 Nov 1;156(11):e214287. doi: 10.1001/jamasurg.2021.4287. Epub 2021 Nov 10.
PubMed 34495283
Study at a glance
From the registry record, last updated by the sponsor on 4 Mar 2021. Recruitment status is as the sponsor reported it: confirm with the study team.
- Official title
- Randomized Controlled Trial for Postoperative opt-in Narcotic Treatment in Outpatient Endocrine Surgery
- ClinicalTrials.gov ID
- NCT04710069
- Acronym / sponsor ID
- POINT / 19-001702
- Conditions
- Postoperative Pain, Narcotic Use, Analgesia, Endocrine Surgery, Opioid Use, Opioid Abuse
- Keywords
- Postoperative Pain, Narcotic Use, endocrine surgery
- Study type
- Interventional
- Recruitment status
- Completed
- Enrolment
- 102 participants (actual)
- Lead sponsor
- University of California, Los AngelesUniversity, hospital or other
- Study start
- 26 Jun 2020 (actual)
- Primary completion
- 30 Jan 2021 (actual)
- Study completion
- 30 Jan 2021 (actual)
- First posted
- 14 Jan 2021 (actual)
- Results
- Not posted in the source record
Clinical summary
The research question as the sponsor registered it. This describes what the study plans to test, not what it found.
pills go unused, generating waste and leaving an opportunity for misuse and abuse.
In a recent study, researchers let patients choose what medications to go home with after surgery. After their thyroid or parathyroid surgery, 96% of patients declined narcotic pain medication. They preferred to manage their pain with acetaminophen instead. Giving patients counseling and empowering them to choose significantly reduces the amount of opioids prescribed and wasted.
The aim of our study is to compare a similar "opt-in" protocol for narcotics to usual care (where patients are routinely discharged with opioids). We would elaborate upon the aforementioned study by studying patient pain scores on a more granular level once they return home.
Our study will be designed as a randomized, controlled trial. When adult patients consent for a thyroid or parathyroid surgery, they will be asked to participate in the study. Patients who are currently using narcotics would be excluded. We would then randomize participants to the "opt-in" protocol versus being provided with a standard opioid prescription after surgery. Patients in the opt-in protocol will be recommended a pain treatment regimen with over-the-counter medications, such as acetaminophen or ibuprofen. These patients will be reassured that if their pain is uncontrolled after discharge, a narcotic prescription will be called in to their pharmacy if requested.
We will assess patient pain scores and medication use in the recovery area using the electronic medical record. We will collect data on patient pain scores and medication use after discharge on a daily basis via phone call or electronically transmitted survey. We will also evaluate patients at the time of their follow-up visits. Any patient phone calls will be routed to study personnel who will fill narcotic prescription requests if requested. Finally, among patients who do receive an opioid prescription, we will track their opioid consumption.
Detailed description
Due to the current opioid epidemic, there has been increased focus on the prescribing patterns of physicians and greater incentive to reduce the amount of narcotic pain medication prescribed.
A prospective study was recently published in Annals of Surgery by Ruffolo et al. which described an opt-in narcotic treatment program for 216 patients who underwent outpatient endocrine cervical surgery (1). Patients were counseled in the pre-operative visit that after the surgery, they would be provided the option of narcotic pain medication versus over-the-counter medication. Prior to discharge, patients were evaluated by a member of the surgical team and offered a choice of postoperative pain medications. The study found only 4% of patients requested narcotic pain medication and achieved a 96.6% reduction in postoperative narcotic use. No patients called in to request narcotic pain medication after discharge.
The study participants were compared to a retrospective cohort of patients who were given narcotic medication postoperatively as the default option. There have been no randomized controlled trials comparing the two pain medication strategies in outpatient cervical endocrine surgery. Additionally, in that study, the level of postoperative pain was not fully assessed and quality of life measures were not studied.
In our institutional practice, having a member of the surgical team visit the patient at the bedside to assess pain level is not part of the standard postoperative work flow, given that the operative team is usually operating at the time the patient is discharged. In order to assess the feasibility of implementing such a program within our practice, we plan to develop alternative methods of presenting the decision for postoperative pain treatment in the immediate postoperative period that fits into our standard practice.
Significance:
Given the current health care and political climate, there has been increasing focus on reducing the amount of narcotics prescribed by health care providers. Based on the results of the above cited study, we believe implementing an opt-in program at UCLA will also significantly decrease the amount of opioids prescribed for postoperative pain. However, we will improve upon that study but assessing pain levels in the week immediately after surgery to ensure patients are not suffering from excessive pain levels at home without notifying providers, and compare these pain levels to patients who are randomized to standard postoperative care (automatically dispensed with a narcotic prescription). We will also assess quality of life measures after surgery to compare the impact of pain management strategy on the postoperative experience.
Ruffolo et al. demonstrated the feasibility in reducing the amount of narcotics prescribed by a significant level by initiating an opt-in program and empowering patients to make their own health care decisions. Incorporating this type of program into the standard operative work flow will maintain efficiency while working towards the goal of reducing narcotic usage. If we can demonstrate the feasibility of implementing such an opt-in program within the section of Endocrine Surgery, expanding the program to other divisions of ambulatory surgery in different surgical subspecialties may also be possible.
- Ruffolo LI, Jackson KM, Juviler P, et al. Narcotic Free Cervical Endocrine Surgery: A Shift in Paradigm. Ann Surg. 9000;Publish Ahead of Print.
Study design
- Primary purpose
- Prevention
- Allocation
- Randomised
- Intervention model
- Parallel groups
- Masking
- Single blind (care provider)
- Number of arms
- 2
| Arm | Type | Receives |
|---|---|---|
| Control/Usual Care | No intervention | –standard treatment of postoperative pain, which involves automatic prescription of a narcotic pain medication regimen after surgery, |
| Opt-in/POINT | Experimental | Behavioral: POINTAn opt-in program (POINT), which requires the patient to consent to receiving a prescription for narcotics |
Who may qualify
- Ages
- 18 years and older
- Sex
- All
- Healthy volunteers
- Accepted
- Age groups
- Adult, Older adult
Key inclusion criteria (1 listed)
- Eligibility for outpatient parathyroidectomy, thyroidectomy or neck dissection Patients aged 18 or older English-speaking: Our provided materials (video instruction, written instructions, survey material) will be in English and we want to ensure clear communication with our study subjects. Once we have demonstrated feasibility of such an opt-in policy with our English-speaking subjects, we will expand our materials to additional languages.
Key exclusion criteria (1 listed)
- Prior history of narcotic use Inpatient admission after surgery
Eligibility is decided by the study team after screening; this overview does not establish that a patient qualifies. Full inclusion and exclusion criteria.
Interventions
| Intervention | Type | Arms |
|---|---|---|
| POINTAlso: Opt-inPatients randomized to the POINT program will be given preoperative counseling on adverse effects of opioids and expectations will be set that most patients do not require opioids for pain control after endocrine surgery, they will receive the info in writing afterwards as well. These patients will also be shown a short instructional video reiterating the counseling provided in the preoperative clinic visit. Information in the video will pertain to the expected pain after surgery, the over-the-counter options for pain control, the risks and side effects of using opioids, and reassurances that opioids may be prescribed at any time after discharge if pain is unmanageable. After the video, the patient will be provided with paperwork, requiring patient consent/signature to receive opioids if they opt into narcotic treatment. They will not be provided with a narcotic prescription if consent is not explicitly provided. | Behavioural | Opt-in/POINT |
Primary outcome
Postoperative pain scores
Time frame: Postoperative Day 0-7
Pain scores will be compared using regression analysis and t-tests.
oral morphine equivalents consumed
Time frame: Postoperative Day 0-7
Possible predictors for narcotic use or higher pain scores will be assessed, including age, sex, type of surgery and preoperative questionnaire (PHQ-9) score using a mixed-effects model.
1 secondary outcome
Postoperative Day 0-7
Time frame: Postoperative Day 7
Results and safety
The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.
Research links
- Official record on ClinicalTrials.govLast updated by the sponsor 4 Mar 2021.
- Background: PubMed 31356280Ruffolo LI, Jackson KM, Juviler P, Kaur R, Chennell T, Glover DM, Linehan DC, Moalem J. Narcotic Free Cervical Endocrine Surgery: A Shift in Paradigm. Ann Surg. 2021 Aug 1;274(2):e143-e149. doi: 10.1097/SLA.0000000000003443.
- Derived from this study: PubMed 34495283Zhu CY, Schumm MA, Hu TX, Nguyen DT, Kim J, Tseng CH, Lin AY, Yeh MW, Livhits MJ, Wu JX. Patient-Centered Decision-making for Postoperative Narcotic-Free Endocrine Surgery: A Randomized Clinical Trial. JAMA Surg. 2021 Nov 1;156(11):e214287. doi: 10.1001/jamasurg.2021.4287. Epub 2021 Nov 10.
- Individual participant dataSharing planned: No
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Referral and contact
AzTrials does not enrol participants or take referrals. Contact the study team or a site listed below; they decide who can take part. This study is not recruiting at the moment.
James Wu, MD principal investigator
University of California, Los Angeles
Michael W Yeh, MD principal investigator
University of California, Los Angeles
1 site in 1 country: see every site and its status.
Questions about this trial
What is this clinical trial studying?
A study testing POINT in people with Postoperative Pain and Narcotic Use, run by University of California, Los Angeles at 1 site in United States.
The full registered description is in the About this study section and the official record.
Who may be eligible to take part?
The sponsor lists 1 inclusion and 1 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.
Is this clinical trial currently recruiting?
The record says: finished, as of the sponsor's last update on 4 Mar 2021. Status can change between updates, so confirm with the study contact before making plans.
Where is the study taking place?
The record lists 1 site in United States. Whether a site is taking part right now should be confirmed with that site. See every site.
What are the possible benefits and risks?
They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.
Are results available for this study?
The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.
How can a doctor refer a patient or contact the research team?
The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.
What does the primary outcome measure?
Postoperative pain scores (time frame: Postoperative Day 0-7). The study lists 2 primary outcomes in all. It is what the study was designed to measure, not a finding.
Where can I read the original study information?
On the ClinicalTrials.gov record for NCT04710069, which also lists 2 linked publications.
Does a listing mean the treatment is approved or proven to work?
No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.
How often is this information updated?
AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 4 Mar 2021.