Stanford pain psychologist Beth Darnall Ph. D had an interesting thread on Twitter this week talking about the EMPOWER Study at Stanford. Dr. Darnall, who has been an outspoken critic of forced tapering of opioids, explained the study is some detail on Twitter.
The EMPOWER study seeks to address multiple unmet needs of patients with chronic pain who desire to reduce long-term opioid therapy and provide the clinical evidence on effective methodology.
The EMPOWER study has been active in 4 states for one year. 220 people enrolled so far and are just now completing some patients. Dr. Darnall says they are receiving “terrific feedback”. It’s whatever opioid reduction goal patients want .
Evidence to date suggests what some chronic pain patients have learned—patients taking long-term opioids require special considerations and protections to prevent potential harms—like increased pain or suffering–from opioid de-prescribing.
Here’s what Dr. Darnall said on Twitter:
“EMPOWER is a *voluntary* opioid tapering study. We do not taper to a predefined dose nor do we ascribe to forced tapering. Our guiding principle is to provide a program that patients want to join and stay in for one year. At baseline, we ask patients the degree of choice they had in the decision to taper opioids and their readiness to taper. Patients complete weekly and monthly electronic surveys from home or wherever is best for them.”
“During their taper, we monitor symptoms weekly and have systems to triage discomfort and adjust the care plan to the individual. We monitor closely for mood changes and suicidality and address issues quickly. Patient safety and comfort are EMPOWER priorities.
“EMPOWER allows for real-time feedback to patients if they report any symptoms or problems. Prescribers receive real-time electronic alerts. We aren’t just collecting data; we are delivering better care to patients while they are in our study. Our prequel study showed that a few patients increased their opioids during a taper study. EMPOWER replicates this individualized opioid prescribing: we treat the *person*, not the pill.”
“Two-thirds of our patients receive self-management and behavioral medicine treatments during their taper. We are studying these treatments to see if they help patients improve on outcomes, they told us were most meaningful to them, like participation in roles and activities.”
“Patients must be taking daily opioids and have chronic pain to be eligible. We screen and exclude for moderate to severe opioid use disorder. Several members of the EMPOWER study team have spoken against harmful tapering practices that have had tragic results for some patients.”
“While *doing no harm* is a basic first step, it is not enough. We bear an ethical and clinical responsibility to ensure our patients are improving across a range of pain and health outcomes during and after opioid taper.”
“Opioid tapering is not right for everyone, and the complexities of pain and medical comorbidities require individualized opioid stewardship. If patients are doing well on opioids, good function, no red flags, and if they do not want to taper: *leave them alone*.designed to prevent iatrogenic harms from opioid reduction, and ensure we are helping patients live better and do more.”
“The EMPOWER patient voice will be the final judge.”
Like all of you, we’ll be interested—very interested—in the results.
You can follow Beth Darnall on Twitter @BethDarnall
You can follow the National Pain Report on Twitter @NatPainReport