Research involving older-adult pain patients at risk of opioid misuse has found that Motivational Interviewing (MI) techniques that physicians could implement rapidly can reduce that risk while also improving other outcomes. In a noteworthy aspect of the study, only the first in a series of MI sessions was actually conducted face-to-face, with the others occurring over the telephone.
“A lot of the participants mentioned at the end of the study, 'If someone could call me regularly just to check on how I'm doing, I would feel supported,'” says lead researcher Yu-Ping Chang, PhD, RN, a psychiatric nursing researcher at the State University of New York's University at Buffalo. Chang says the telephone sessions were selected for this study because of concerns that the 50-and-older group might not feel particularly comfortable with sessions conducted over the Internet.
The research offers hope for implementation of relatively accessible strategies in primary care to prevent opioid misuse and abuse. It won't come as a surprise to many in the specialty addiction field that this study featured patients who had been receiving opioids for chronic pain—despite the lack of evidence that the potentially addictive medications are actually effective for that purpose.
While Chang believes that primary care physicians who prescribe pain medication need to become more educated on non-addictive alternatives for treatment, she adds that they also need not be afraid that MI counseling could create an added burden in their already fast-paced practices.
“I believe they would see how easy it is to implement it,” she says. “People try to equate MI with psychotherapy, and it shouldn't be. These techniques can be implemented in a period as short as three minutes.”
Details of study
While MI has been shown to reduce some problematic health behaviors, it had not been studied to this point for its potential in promoting opioid medication adherence in older adults. This study, published in Perspectives in Psychiatric Care, involved patients ages 50 and older who were prescribed opioids for chronic nonmalignant pain and were rated at risk for misuse according to the Screener and Opioid Assessment for Patients with Pain.
Patients received one in-person MI session (from a researcher or a nurse practitioner) and were then told to expect weekly phone calls for the next three weeks. The sessions focused on areas such as reflective listening so that patients felt understood, affirmations to support self-efficacy, and other strategies to help enhance participants' commitment to change. Patients who also used alcohol benefited from education discussing the risks of mixing alcohol and prescription medication.
The positive, strengths-based interactions inherent in MI might be foreign to some physicians' way of doing things. “Primary care physicians want to fix everything,” Chang says. “When they see the patients doing something, they'll want to correct them. The patient won't listen twice, and this creates barriers for change.”
A total of 30 patients with a median age of 59.1 completed the study (Chang said the sample size was deliberately kept small because this was the first study of its kind). Participants showed a signifcant reduction in risk of prescription opioid misuse at the end of the study and at a one-month follow-up stage. Moreover, those who used alcohol saw reductions in drinking, and there was an increase in readiness to change as well as a decrease in depression and anxiety levels.
Chang says of MI, therefore, “It can work on multiple outcomes, not just what you're primarily testing for.”