2023
Long-term opioid therapy trajectories and overdose in patients with and without cancer.
Merlin J, Black A, Midboe A, Troszak L, Asch S, Bohnert A, Fenton B, Giannitrapani K, Glassman P, Kerns R, Silveira M, Lorenz K, Abel E, Becker W. Long-term opioid therapy trajectories and overdose in patients with and without cancer. BMJ Oncology 2023, 2: e000023. PMID: 38259328, PMCID: PMC10802123, DOI: 10.1136/bmjonc-2022-000023.Peer-Reviewed Original ResearchLong-term opioid therapyVeterans Health Administration databaseRetrospective cohort studyCornerstone of managementOpioid overdose riskHealth Administration databaseOpioid-related overdosesPresence of cancerRole of cancerOpioid receiptOpioid therapyCohort studyConclusions PatientsMost patientsObjective painOpioid risksDose/Opioid overdoseOverdose riskInternational ClassificationLower riskPatientsEffect of trajectoriesCancerAdministration database
2022
Long-term Opioid Therapy and Overdose in Patients with and without Cancer
Merlin J, Black A, Midboe A, Troszak L, Asch S, Bohnert A, Fenton B, Giannitrapani K, Glassman P, Kerns R, Silveira M, Lorenz K, Becker W. Long-term Opioid Therapy and Overdose in Patients with and without Cancer. Journal Of Pain 2022, 23: 60. DOI: 10.1016/j.jpain.2022.03.225.Peer-Reviewed Original ResearchLong-term opioid therapyOpioid therapyCox proportional hazard modelingElectronic health record databaseCancer pain managementRetrospective cohort studyProportional hazard modelingOpioid overdose riskHealth record databasePresence of cancerRole of cancerOpioid receiptCohort entryCohort studyHazard ratioMost patientsPain managementOpioid risksDose/Inclusion criteriaOpioid overdoseOverdose riskLatent growth mixture modelingLower riskPatientsAssociation Between Exposure to Complementary and Integrative Therapies and Opioid Analgesic Daily Dose Among Patients on Long-term Opioid Therapy
Black AC, Zeliadt SB, Kerns RD, Skanderson M, Wang R, Gelman H, Douglas JH, Becker WC. Association Between Exposure to Complementary and Integrative Therapies and Opioid Analgesic Daily Dose Among Patients on Long-term Opioid Therapy. The Clinical Journal Of Pain 2022, 38: 405-409. PMID: 35440528, DOI: 10.1097/ajp.0000000000001039.Peer-Reviewed Original ResearchConceptsLong-term opioid therapyMorphine equivalent daily doseVeterans Health AdministrationDaily doseCIH exposureOpioid doseOpioid therapyWhole health systemCIH useVHA electronic health recordsIntegrative health modalitiesOpioid analgesic doseMean starting doseMental health diagnosesElectronic health recordsAnalgesic doseCIH therapiesNonopioid treatmentCohort entryOpioid taperingStarting doseAdverse eventsPain intensityChiropractic careVHA facilities
2021
Psychological Interventions for the Treatment of Chronic Pain in Adults
Driscoll MA, Edwards RR, Becker WC, Kaptchuk TJ, Kerns RD. Psychological Interventions for the Treatment of Chronic Pain in Adults. Psychological Science In The Public Interest 2021, 22: 52-95. PMID: 34541967, DOI: 10.1177/15291006211008157.Peer-Reviewed Original ResearchConceptsPsychological interventionsCognitive behavioral therapyChronic painPrimary conceptual frameworkPsychological processesCo-occurring disordersIndividual differencesPsychological treatmentPsychological approachResilience factorsCommitment TherapyExpression therapyBiopsychosocial modelAdditional scientific knowledgeComplex experienceImpact of painMultiple pain conditionsSerious public health concernModel of carePublic health concernInterventionOpioid therapyAdultsPain conditionsMindfulness
2020
All-cause mortality among males living with and without HIV initiating long-term opioid therapy, and its association with opioid dose, opioid interruption and other factors
Gordon K, Manhapra A, Crystal S, Dziura J, Edelman E, Skanderson M, Kerns R, Justice A, Tate J, Becker W. All-cause mortality among males living with and without HIV initiating long-term opioid therapy, and its association with opioid dose, opioid interruption and other factors. Drug And Alcohol Dependence 2020, 216: 108291. PMID: 33011662, PMCID: PMC7644145, DOI: 10.1016/j.drugalcdep.2020.108291.Peer-Reviewed Original ResearchConceptsMorphine equivalent daily doseCause mortalityLong-term opioid therapyTime-updated Cox regressionStrong dose-response relationshipUnnatural deathsEquivalent daily doseDose-response relationshipOpioid doseOpioid therapyUninfected patientsOpioid useDaily doseCox regressionMortality outcomesTherapy doseHigh doseMale veteransOverdose fatalitiesOverdose mortalityPLWHMortalityHIVPatientsDoseTreatment of a Large Cohort of Veterans Experiencing Musculoskeletal Disorders with Spinal Cord Stimulation in the Veterans Health Administration: Veteran Characteristics and Outcomes
Wandner LD, Fenton BT, Goulet JL, Carroll CM, Heapy A, Higgins DM, Bair MJ, Sandbrink F, Kerns RD. Treatment of a Large Cohort of Veterans Experiencing Musculoskeletal Disorders with Spinal Cord Stimulation in the Veterans Health Administration: Veteran Characteristics and Outcomes. Journal Of Pain Research 2020, 13: 1687-1697. PMID: 32753944, PMCID: PMC7354010, DOI: 10.2147/jpr.s241567.Peer-Reviewed Original ResearchMusculoskeletal disordersSCS implantsOpioid therapyPain scoresVeterans Health Administration facilitiesSpinal cord stimulator implantationOutcomes of veteransPainful musculoskeletal disordersSpinal cord stimulationVeterans Health AdministrationDepressive disorder diagnosisEvidence of benefitSubstance use disordersPercent of veteransSignificant overall decreaseMSD cohortOpioid doseBMI 25Medical comorbiditiesStimulator implantationChronic painCord stimulationInclusion diagnosisVeteran characteristicsLarge cohort
2019
Graded chronic pain scale revised: mild, bothersome, and high-impact chronic pain.
Von Korff M, DeBar LL, Krebs EE, Kerns RD, Deyo RA, Keefe FJ. Graded chronic pain scale revised: mild, bothersome, and high-impact chronic pain. Pain 2019, 161: 651-661. PMID: 31764390, PMCID: PMC7097879, DOI: 10.1097/j.pain.0000000000001758.Peer-Reviewed Original ResearchConceptsHigh-impact chronic painMild chronic painChronic Pain ScaleGraded Chronic Pain ScaleChronic painPain Scale-RevisedPain scaleLong-term opioid therapySubstantial activity limitationsHealth status indicatorsOpioid therapyAdult enrolleesActivity limitationsPainPain metricsHealth plansNonsignificant differenceStatus indicatorsPersonsValid methodTherapyPrevalenceBothersomeEnrolleesSignature Informed Consent for Long-Term Opioid Therapy in Patients With Cancer: Perspectives of Patients and Providers
Giannitrapani KF, Fereydooni S, Azarfar A, Silveira MJ, Glassman PA, Midboe AM, Bohnert ABS, Zenoni MA, Kerns RD, Pearlman RA, Asch SM, Becker W, Lorenz KA. Signature Informed Consent for Long-Term Opioid Therapy in Patients With Cancer: Perspectives of Patients and Providers. Journal Of Pain And Symptom Management 2019, 59: 49-57. PMID: 31476361, DOI: 10.1016/j.jpainsymman.2019.08.020.Peer-Reviewed Original ResearchConceptsLong-term opioid therapyCancer-related painOpioid therapyVeterans Health Administration medical centersInformed consentAppropriate literacy levelPerspectives of patientsPatient-provider relationshipCancer-related concernsOpioid useOpioid prescribersPatient interviewsPatient educationMedical CenterPatientsPainProvider perspectivesTherapyCancerConsentLiteracy levelsProvidersPotential disadvantagesEmergent themesOpioidsEnhancing Motivation for Change in the Management of Chronic Painful Conditions: a Review of Recent Literature
Ankawi B, Kerns RD, Edmond SN. Enhancing Motivation for Change in the Management of Chronic Painful Conditions: a Review of Recent Literature. Current Pain And Headache Reports 2019, 23: 75. PMID: 31388839, DOI: 10.1007/s11916-019-0813-x.Peer-Reviewed Original ResearchConceptsNon-pharmacological treatmentChronic painPsychosocial influencesMotivational factorsTreatment adherenceRecent empirical researchHeadache disordersHealth treatmentIntervention feasibilityMotivationRecent FindingsResearchLong-term opioid therapyEmpirical researchChronic painful conditionsInitiation of treatmentDisordersInterventionOpioid therapyTreatment initiationTreatment outcomesPainful conditionsReviewThe purposeElectronic treatmentCommon factorsPain
2018
Testing implementation facilitation of a primary care-based collaborative care clinical program using a hybrid type III interrupted time series design: a study protocol
Midboe AM, Martino S, Krein SL, Frank JW, Painter JT, Chandler M, Schroeder A, Fenton BT, Troszak L, Erhardt T, Kerns RD, Becker WC. Testing implementation facilitation of a primary care-based collaborative care clinical program using a hybrid type III interrupted time series design: a study protocol. Implementation Science 2018, 13: 145. PMID: 30486877, PMCID: PMC6262952, DOI: 10.1186/s13012-018-0838-2.Peer-Reviewed Original ResearchMeSH KeywordsAnalgesics, OpioidCooperative BehaviorEvidence-Based PracticeHumansImplementation ScienceInservice TrainingInterrupted Time Series AnalysisPain ManagementPractice Patterns, Physicians'Primary Health CareProgram EvaluationResearch DesignUnited StatesUnited States Department of Veterans AffairsWork EngagementConceptsCollaborative care interventionVeterans Health AdministrationImplementation facilitationPrimary careCare interventionsHigh-dose opioid therapyMorphine equivalent daily doseVHA health care systemClinical programsImplementation facilitation strategyOutpatient opioid prescriptionsOpioid prescribing practicesPain management servicesCollaborative care programEquivalent daily dosePrimary care clinicsPrimary care providersRE-AIM frameworkInterrupted time seriesOpioid overdose crisisHealth care systemInterrupted time series designEligible patientsMedication taperingOpioid therapyDuration of opioid prescriptions predicts incident nonmedical use of prescription opioids among U.S. veterans receiving medical care
Barry DT, Marshall BDL, Becker WC, Gordon AJ, Crystal S, Kerns RD, Gaither JR, Gordon KS, Justice AC, Fiellin DA, Edelman EJ. Duration of opioid prescriptions predicts incident nonmedical use of prescription opioids among U.S. veterans receiving medical care. Drug And Alcohol Dependence 2018, 191: 348-354. PMID: 30176548, PMCID: PMC6596307, DOI: 10.1016/j.drugalcdep.2018.07.008.Peer-Reviewed Original ResearchConceptsPrescription opioid receiptPrescription opioidsMedical careOpioid receiptVeterans Health Administration primary careNonmedical useMultivariable Cox modelInfectious disease clinicProspective cohort studyProportional hazards regressionPrescription opioid medicationsPublic health problemSubstance use disordersMedication-related characteristicsOpioid therapyOpioid medicationsOpioid prescriptionsCohort studyDisease clinicMedian ageHazards regressionEligible participantsPrimary careRisk factorsIncidence rateRacial disparities in discontinuation of long-term opioid therapy following illicit drug use among black and white patients
Gaither JR, Gordon K, Crystal S, Edelman EJ, Kerns RD, Justice AC, Fiellin DA, Becker WC. Racial disparities in discontinuation of long-term opioid therapy following illicit drug use among black and white patients. Drug And Alcohol Dependence 2018, 192: 371-376. PMID: 30122319, PMCID: PMC7106601, DOI: 10.1016/j.drugalcdep.2018.05.033.Peer-Reviewed Original ResearchConceptsLong-term opioid therapyIllicit drug useUrine drug testsDrug useOpioid therapyWhite racePositive urine drug testDrug testsMonths of treatmentElectronic medical recordsWhite patientsChronic painPatient raceMedical recordsPatientsLogistic regressionOpioidsRacial disparitiesDrug testingCocaineCannabisTherapyCliniciansDiscontinuationPainAssociation Between Facility-Level Utilization of Non-pharmacologic Chronic Pain Treatment and Subsequent Initiation of Long-Term Opioid Therapy
Carey EP, Nolan C, Kerns RD, Ho PM, Frank JW. Association Between Facility-Level Utilization of Non-pharmacologic Chronic Pain Treatment and Subsequent Initiation of Long-Term Opioid Therapy. Journal Of General Internal Medicine 2018, 33: 38-45. PMID: 29633137, PMCID: PMC5902343, DOI: 10.1007/s11606-018-4324-y.Peer-Reviewed Original ResearchConceptsLong-term opioid therapyNon-pharmacologic treatmentsFacility-level variationNon-opioid medicationsChronic painOpioid therapyTreatment modalitiesVeterans Health Administration facilitiesPatient-reported painChronic pain treatmentChronic pain careImproved patient outcomesUtilization patternsOpioid treatmentPrior calendar yearMedication utilizationPatient characteristicsPain treatmentPain careKey ResultsAmongPrimary carePatient outcomesPainGreater utilizationAdministration facilities
2017
Multiple Sources of Prescription Payment and Risky Opioid Therapy Among Veterans
Becker WC, Fenton BT, Brandt CA, Doyle EL, Francis J, Goulet JL, Moore BA, Torrise V, Kerns RD, Kreiner PW. Multiple Sources of Prescription Payment and Risky Opioid Therapy Among Veterans. Medical Care 2017, 55: s33-s36. PMID: 28410338, DOI: 10.1097/mlr.0000000000000722.Peer-Reviewed Original ResearchConceptsOpioid therapySource of paymentHigher oddsHigh-dose opioid therapyHigh-risk opioid prescribingMorphine equivalent daily dosePayment sourceOpioid analgesic prescriptionsPrescription monitoring programsEquivalent daily doseCross-sectional studyAnalgesic prescriptionOpioid prescribingBenzodiazepine therapyDaily doseUS veteransFiscal year 2014TherapyPrivate insuranceLogistic regressionRelated harmsPrescription paymentAnalytic sampleOpioidsOdds
2016
The Effect of Substance Use Disorders on the Association Between Guideline-concordant Long-term Opioid Therapy and All-cause Mortality
Gaither JR, Goulet JL, Becker WC, Crystal S, Edelman EJ, Gordon K, Kerns RD, Rimland D, Skanderson M, Justice AC, Fiellin DA. The Effect of Substance Use Disorders on the Association Between Guideline-concordant Long-term Opioid Therapy and All-cause Mortality. Journal Of Addiction Medicine 2016, 10: 418-428. PMID: 27610580, PMCID: PMC5083184, DOI: 10.1097/adm.0000000000000255.Peer-Reviewed Original ResearchConceptsSubstance use disordersLong-term opioid therapyCause mortalityOpioid therapySUD treatmentUse disordersLower mortalityTime-updated Cox regressionUntreated substance use disordersVeterans Aging Cohort StudyOpioid-prescribing guidelinesGuideline-concordant careSUD statusAging Cohort StudyClinical practice guidelinesSUD treatment servicesOverall sampleHIV patientsCohort studyCox regressionPractice guidelinesPatientsTreatment servicesHigh mortalityMortalityThe Association Between Receipt of Guideline-Concordant Long-Term Opioid Therapy and All-Cause Mortality
Gaither JR, Goulet JL, Becker WC, Crystal S, Edelman EJ, Gordon K, Kerns RD, Rimland D, Skanderson M, Justice AC, Fiellin DA. The Association Between Receipt of Guideline-Concordant Long-Term Opioid Therapy and All-Cause Mortality. Journal Of General Internal Medicine 2016, 31: 492-501. PMID: 26847447, PMCID: PMC4835362, DOI: 10.1007/s11606-015-3571-4.Peer-Reviewed Original ResearchConceptsSubstance use disordersGuideline-concordant careCause mortalityOpioid therapyLong-term opioid therapyUntreated substance use disordersCurrent substance use disorderTerm opioid therapyTime-updated covariatesPrimary care visitsImportant clinical outcomesMulti-modal treatmentUrine drug testingUninfected patientsUntreated patientsCare visitsChronic painClinical outcomesCox regressionDecreased riskHigh comorbidityMortality burdenRehabilitative therapySUD treatmentHigh riskStepped care model of pain management and quality of pain care in long-term opioid therapy
Moore BA, Anderson D, Dorflinger L, Zlateva I, Lee A, Gilliam W, Tian T, Khatri K, Ruser CB, Kerns RD. Stepped care model of pain management and quality of pain care in long-term opioid therapy. The Journal Of Rehabilitation Research And Development 2016, 53: 137-146. PMID: 27006068, DOI: 10.1682/jrrd.2014.10.0254.Peer-Reviewed Original ResearchInitial development of patient-reported instrument assessing harm, efficacy, and misuse of long-term opioid therapy
Becker WC, Fiellin DA, Black AC, Kostovich CT, Kerns RD, Fraenkel L. Initial development of patient-reported instrument assessing harm, efficacy, and misuse of long-term opioid therapy. The Journal Of Rehabilitation Research And Development 2016, 53: 127-136. PMID: 27006339, PMCID: PMC4806533, DOI: 10.1682/jrrd.2014.11.0285.Peer-Reviewed Original ResearchConceptsLong-term opioid therapyPatient-reported instrumentOpioid therapyFurther item reductionIneffective medicationsClinical outcomesPrimary careFrequent reassessmentPatient comprehensionItem reductionGold standardEfficacyTherapyInterdisciplinary teamLevel checksCognitive interviewsMisuseHarmMedicationsPatients
2015
Combined Use of Opioids and Antidepressants in the Treatment of Pain: A Review of Veterans Health Administration Data for Patients with Pain Both With and Without Co-morbid Depression
Sellinger JJ, Sofuoglu M, Kerns RD, Rosenheck RA. Combined Use of Opioids and Antidepressants in the Treatment of Pain: A Review of Veterans Health Administration Data for Patients with Pain Both With and Without Co-morbid Depression. Psychiatric Quarterly 2015, 87: 585-593. PMID: 26646578, DOI: 10.1007/s11126-015-9411-1.Peer-Reviewed Original ResearchConceptsVeterans Health AdministrationMusculoskeletal painAntidepressant useVeterans Health Administration dataAnnual opioid prescriptionsNational VHA databasesUse of antidepressantsCo-morbid depressionTreatment of painHealth Administration dataMajor depressive disorderNon-depressed groupOpioid therapyAnalgesic benefitOpioid prescribingOpioid prescriptionsPrescribing patternsOpioid useVHA databasesFiscal year 2012Depressive disorderDepression diagnosisPainAntidepressantsOpioids
2014
A Partnered Approach to Opioid Management, Guideline Concordant Care and the Stepped Care Model of Pain Management
Dorflinger L, Moore B, Goulet J, Becker W, Heapy AA, Sellinger JJ, Kerns RD. A Partnered Approach to Opioid Management, Guideline Concordant Care and the Stepped Care Model of Pain Management. Journal Of General Internal Medicine 2014, 29: 870-876. PMID: 25355083, PMCID: PMC4239281, DOI: 10.1007/s11606-014-3019-2.Peer-Reviewed Original ResearchConceptsLong-term opioid therapyOpioid risk mitigation strategiesOpioid therapyGuideline-concordant careVeterans Health AdministrationPain managementStepped care modelOpioid managementChronic painPain carePrimary carePractice guidelinesCare modelHigh-dose opioidsKey ResultsThe proportionProportion of patientsNon-opioid analgesicsClinical practice guidelinesCommon presenting problemManagement of veteransPerformance improvement outcomesClinical research teamInteractive educational strategiesFour-year study periodConcordant care