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I went to medical school knowing I wanted to pursue primary care and have been doing so for 28 years. Being a doctor is so much more than prescribing medicine, it is getting to really know you, taking time to listen and understand your life situation, your aspirations and even fears. There are many determinants of someone’s health: your past experiences, your current circumstance, and your goals for the future all need to be taken into account. I consider it a privilege to know my patients over many years and to be able to help you achieve fulfillment in life despite ailments, acute or chronic. If you would like to know my past, present, and future goals, I’ll tell you briefly that I was born and raised in Belgium, came to the US at age 19 to study at UCLA and UCSF Medicine, and met an earthquake researcher who has been my husband for 33 years. We have two children, both in college. I love to travel, hike, garden, take photographs but above all, spend time with my family. I hope to keep practicing medicine for many more years and thus continue to meet people from all around the country and world who teach me so many valuable life lessons. I feel fortunate to be part of the Stanford community.
Department of Medicine funded project to educate patients on how opioid tapering is done.Through the story told by a real patient who tapered off opioid medications over a two year period, and using animated images we walk the viewers through the process of tapering, discussing the rationale for tapering, how it is done, what to expect in terms of both potential withdrawal symptoms and long term benefits, and a brief discussion on self-care with chronic pain syndromes. Based off the Stanford CME course by Dr Anna Lembke on Opioid Tapering. https://www.youtube.com/watch?v=BCtYqEOjK-Y&feature=youtu.be
California Health Care Foundation and Santa Clara County Department of Alcohol and Drug Services
The EMPOWER study- a patient centered opioid tapering study for patient with chronic pain on long-term opioid therapy. Funding: PCORI PI: Dr Beth DarnallStudies suggest that long-term opioid use for chronic pain does not help reduce pain or help patients live fuller lives. Opioid medications have major health risks, even when taken exactly as prescribed, including worsening pain. There are no studies that tell prescribers how to best address their patients’ concerns and engage them in opioid reduction, and how to best help them achieve meaningful and successful outcomes that last long-term. Our patients told us that for opioid reduction to be successful, the benefit of lower dosage needs to be well understood by them. Further, the patients want to work with their doctors to create together such opioid reduction treatment plan. Based on such input, we developed a patient-centered study that encourages patient interest and willingness to actively and collaboratively reduce opioids use and test 2 well established behavioral intervention pain treatment. Study aims: We will test which of the two types of pain management classes described below is best for reducing pain and pain interference, increasing function, and reducing opioids within the context of active, collaborative, patient-centered opioid reduction that addresses their main concerns. Study description: We will study the effectiveness of two types of active behavioral pain management treatment classes in patients prescribed long-term opioids from primary care and pain clinics in 4 states in the Western U.S. Patients who wish to reduce opioids will collaborate with their doctor to co-create a tailored plan to reduce their opioids. Recognizing that some patients are not ready to reduce opioids, we will also enroll patients who decided not to increase their opioid dose during the one-year study period (opioid dose containment group). All study patients will be assigned to either 8-week group Cognitive Behavioral Therapy for chronic pain, 6-week peer-led Chronic Pain Self-Management Program, or no behavioral treatment. Our two active behavioral treatment groups are evidence-based and widely available. We will determine which behavioral treatment works best and for whom for pain control, functioning and opioid reduction at 12 months within the context of collaborative opioid reduction. We will determine whether the behavioral treatments help improve readiness to reduce opioids for those who elected to hold their opioid dose constant. Our primary outcomes were informed by our patient stakeholders and include pain intensity, opioid use, pain interference, role function, anxiety, depression, pain catastrophizing, sleep, fatigue, and medication side effects. Patients with any type of chronic pain may enroll except for such patients with active addiction, behavioral or safety concerns. Our project focuses on community outpatient settings where most U.S. patients receive prescribed opioids. Our project is designed such that the results can be broadly applied to anywhere in the US.
Cognitive Behavioral Therapy and Chronic Pain Self-Management Within the Context of Opioid Reduction: The EMPOWER Study
The proposed study will fill several critical gaps in evidence that are preventing patients
and physicians from making informed decisions about their pain care. This project will
provide patients taking opioids and physicians with the specific evidence they need to choose
the most effective route to pain control, reduced pain interference, opioid reduction, and
improved role function, thereby improving patient care.
The aims of this study are to (1) reduce or contain prescription opioid use while maintaining
pain control and (2) compare the effectiveness of the Chronic Pain Self-Management Program
(CPSMP), Cognitive Behavioral Therapy for chronic pain (pain-CBT), and no behavioral
treatment within the context of patient-centered collaborative opioid tapering (Taper Only).
The acronym EMPOWER stands for Effective Management of Pain and Opioid-Free Ways to Enhance
To learn more about the EMPOWER study, please visit: empower.stanford.edu.
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