Capsule Commentary on Odineal et al., Effect of Mobile Device-Assisted N-of-1 Trial Participation on Analgesic Prescribing for Chronic Pain: Randomized Controlled Trial

Excerpt

In this study, Odineal and colleagues¹ examined changes in prescription analgesic prescribing for approximately 200 patients with chronic pain randomized to either a mobile app–enabled N-of-1 study (tailored, individualized pain-control interventions) or a control group. The app allowed patients to choose two treatment plans to compare over several short trials, selecting from a list of commonly prescribed analgesics or non-pharmaceutical therapies such as yoga or physical therapy. Among intervention patients, the authors found a clinically and statistically significant decrease in NSAID prescriptions relative to controls. Nearly one-quarter of intervention patients stopped NSAIDs during the study period, and the between-group difference was also significant. The study also found that intervention patients had a clinically (but not statistically) significant reduction in opioid use among those prescribed at least 20 morphine milligram equivalents daily relative to controls. Deprescribing opioids can take many months, and the study may have been underpowered to demonstrate statistical significance among patients with opioid prescriptions, but the results show promise in tools that assist with opioid deprescribing. …