Principal Investigator

Desiree R
Azizoddin
Awardee Organization

University Of Oklahoma Hlth Sciences Ctr
United States

Fiscal Year
2023
Activity Code
R21
Early Stage Investigator Grants (ESI)
Not Applicable
Project End Date

Leveraging mHealth to deliver integrated pain-CBT, opioid monitoring, and self-management support for advanced cancer patients coping with chronic pain

Pain affects approximately two thirds of patients with advanced cancer, with rates approaching 90% near the end-of-life. Although pharmacotherapy is vitally important to alleviating chronic cancer pain, psychological factors also substantially influence pain outcomes. Cognitive Behavioral Therapy for pain (pain-CBT) is effective for chronic cancer and non-malignant pain. Unfortunately, pain-CBT in its traditional format (60minute, in-person sessions for 12-16 weeks) is unrealistic for advanced cancer patients. Effective biopsychosocial cancer pain management requires substantial adaptation to meet the real-life needs of advanced cancer patients and should ideally integrate with pharmacotherapy support. Given the expansive need, mobile health technology is a promising strategy to deliver and ultimately disseminate brief, pain-CBT interventions to cancer patients. Our goal is to improve advanced cancer patients' pain self-management by adapting and integrating pain-CBT into our existing mHealth program designed to support patients' pharmacologic management. Our parent intervention, STAMP (Smartphone Technology to Alleviate Malignant Pain) is a patient-facing smartphone application that supports daily symptom and opioid monitoring, and delivers tailored pain psychoeducation and advice. We have a strategic opportunity to adapt and integrate pain-CBT to create novel mHealth intervention that harmonizes psychological and medical support for advanced cancer pain. Leveraging mobile technology, we will simulate the therapeutic experience of pain-CBT by 1) presenting advanced cancer-specific, multimedia psychoeducational content, 2) developing schedules to deliver daily, brief didactics, 3) facilitating insight building via surveys and tailored feedback, & 4) stimulating active learning through gamified cognitive restructuring exercises and audio-recorded relaxations. In Aim 1: We will supplement our multi-media library of cancer pain psycho-education and adapt pain-CBT content for brief mHealth delivery specific to advanced cancer, while integrating clinician and patient (n=20) feedback throughout. In Aim 2: 25 patients with chronic pain from advanced cancer will use STAMP+CBT for 6 weeks. Findings will illuminate feasibility of app use and data collection for a larger future efficacy trial (R01), allowing for exploration of meaningful trends in pain, psychological mediators, and care utilization. If proven effective, this pain-CBT and opioid management intervention has great potential to scale and make biopsychosocial pain treatment available to a population that suffers disproportionately from chronic pain and has little access to non-pharmacologic pain management treatments.

Publications

  • DeForge SM, Smith K, Anderson KA, Baltazar AR, Beck M, Enzinger AC, Tulsky JA, Allsop M, Edwards RR, Schreiber KL, Azizoddin DR. Pain coping, multidisciplinary care, and mHealth: Patients' views on managing advanced cancer pain. Psycho-oncology. 2024 Feb;33(2):e6308. PMID: 38366975
  • Azizoddin DR, Thomas TH. Game Changer: Is Palliative Care Ready for Games? JCO clinical cancer informatics. 2022 Mar;6:e2200003. PMID: 35482999
  • Azizoddin DR, DeForge SM, Baltazar A, Edwards RR, Allsop M, Tulsky JA, Businelle MS, Schreiber KL, Enzinger AC. Development and pre-pilot testing of STAMP + CBT: an mHealth app combining pain cognitive behavioral therapy and opioid support for patients with advanced cancer and pain. Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer. 2024 Jan 22;32(2):123. PMID: 38252172

Clinical Trials

Study Name Clinical Trial ID
Psychological Intervention Using Smartphone Technology to Alleviate Malignant Pain NCT05774197