Study of Multimodal Pain Care and Medication Strategies to Reduce Long-Term Opioid Use in Cancer Survivors

What this Trial Is About

Researchers are evaluating four different approaches to reduce long-term opioid use in cancer survivors who continue to experience chronic pain after completing cancer treatment. The study focuses on Veterans who have used opioids for a long time, aiming to find safer alternatives to manage their pain without worsening their symptoms. This trial addresses an important gap since current programs do not offer evidence-based options for opioid reduction in this group. It is a phase 4, randomized, two-stage trial conducted by the VA Office of Research and Development. Participants will be randomized to receive either multimodal pain care or medication optimization for the first six months. Multimodal pain care includes behavioral therapy, physical therapy, assistive devices like TENS or bracing, specialist referrals, and complementary therapies such as acupuncture or massage. Medication optimization involves adjusting non-opioid pain medications based on established guidelines. After six months, those who do not respond will be assigned to either buprenorphine rotation, where they switch from their current opioid to buprenorphine, or opioid tapering following VA recommendations. The study lasts nine months with different treatment stages. During the study, participants will undergo comprehensive pain assessments and regular monitoring of opioid doses and pain interference at six and nine months. Researchers will measure opioid dose reduction combined with changes in pain interference as the primary outcome. Secondary outcomes include opioid dose alone, pain intensity, and pain interference. The study also aims to understand challenges in implementing each treatment to help integrate successful strategies into VA care for cancer survivors on long-term opioid therapy.

Better Options for Chronic Cancer Pain