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Research Shows How AI Can Help Reduce Opioid Use After Surgery

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Research coming out of the University of Pennsylvania School of Medicine last month demonstrated how artificial intelligence (AI) can be utilized to fight against opioid abuse. It focused on a chatbot which sent reminders to patients who underwent surgery to fix major bone fractures. 

The research was published in the Journal of Medical Internet Research

Christopher Anthony, MD, is the study’s lead author and the associate director of Hip Preservation at Penn Medicine. He is also an assistant professor of Orthopaedic Surgery. 

“We showed that opioid medication utilization could be decreased by more than a third in an at-risk patient population by delivering psychotherapy via a chatbot,” he said. “While it must be tested with future investigations, we believe our findings are likely transferable to other patient populations.”

Opioid Use After Surgery

Opioids are an effective treatment for pain following a severe injury, such as a broken arm or leg, but the large prescription of the drugs can lead to addiction and dependence for many users. This is what has caused the major opioid epidemic throughout the United States. 

The team of researchers believe that a patient-centered approach with the use of the AI chatbot can help reduce the number of opioids taken after such surgerys, which can be a tool used against the epidemic. 

Those researchers also included Edward Octavio Rojas, MD, who is a resident in Orthopaedic Surgery at the University of Iowa Hospitals & Clinics. The co-authors included: Valerie Keffala, PhD; Natalie Ann Glass, PhD; Benjamin J. Miller, MD; Mathew Hogue, MD; Michael Wiley, MD; Matthew Karam, MD; John Lawrence Marsh, MD, and Apurva Shah, MD. 

The Experiment

The research involved 76 patients who visited a Level 1 Trauma Center at the University of Iowa Hospitals & Clinics. They were there to receive treatment for fractures that required surgery, and those patients were separated into two groups. Both groups received the same prescription for opioids to treat pain, but only one of the groups received daily text messages from the automated chatbot. 

The group that received text messages could expect two per day for a period of two weeks following their procedure. The automated chatbot relied on artificial intelligence to send the messages, which went out the day after surgery. The text messages were constructed in a way to help patients focus on coping better with the medication. 

The text messages, which were created by a pain psychologist specialized in pain and commitment therapy (ACT), did not directly go against the use of the medication, but they attempted to help the patients think of something other than taking a pill.

Six Core Principles

The text messages could be broken down into six “core principles,” : Values, Acceptance, Present Moment Awareness, Self-As-Context, Committed Action, and Diffusion.

One message under the Acceptance principle was: “feelings of pain and feelings about your experience of pain are normal after surgery. Acknowledge and accept these feelings as part of the recovery process. Remember how you feel now is temporary and your healing process will continue. Call to mind pleasant feelings or thoughts you experienced today.” 

The results showed that the patients who did not receive the automated messages took, on average, 41 opioid pills following the surgeries, while the group who did receive the messages averaged 26. The 37 percent difference was impressive, and those who received messages also reported less overall pain two weeks after the surgery. 

The automated messages were not personalized for each individual, which demonstrates success without over-personalization.

“A realistic goal for this type of work is to decrease opioid utilization to as few tablets as possible, with the ultimate goal to eliminate the need for opioid medication in the setting of fracture care,” Anthony said. 

The study received funding by a grant from the Orthopaedic Trauma Association.