By Martin Seneviratne, MD
The opioid crisis has been declared a public health emergency, with an estimated 115 deaths each day in the United States from opioid overdoses. In response, the National Institutes of Health launched the HEAL initiative (Helping to End Addiction Long-term) in April this year – a far-reaching research program to prevent addiction and treat long-term users.
One particular challenge is how to manage opioid prescribing after surgery. On one hand, patients need appropriate pain management and opioids are extremely effective. However, excess opioid prescribing is a gateway to overuse.
This was the problem targeted by the winning team of the Nokia Medicine X Digital Health Challenge – an international research challenge using wearables to investigate clinical problems.
The interdisciplinary team, led by Drs Kate Meacham and Michael Bottros from Washington University in St Louis, used smart watches to track the physical activity and sleep patterns of 36 patients for 30 days following knee arthroplasty. They correlated these data with opioid prescribing patterns and actual opioid used (with patients self-reporting via a smartphone app).
The key result was that the average amount of opioids used per day was much less than the total amount prescribed. In addition, they found that early sleep disturbances were associated with high opioid consumption down the track.
“Behavioral data is an extremely useful way to track pain management,” said Dr Meacham. The team hypothesize that it may be possible to better personalize pain management after surgery by using behavioral data from connected health devices.
There were some challenges during the study, including patient compliance and technology literacy. The task of embedding a digital health tool into a patient’s life and a clinicians workflow required a lot of work. However patients were generally curious to find out more about their sleep and exercise patterns.
“The way forward for digital health tools is seamless integration with clinician data to provide the best recommendations for our patients,” said Dr. Bottros. For the opioid crisis, the hope is that digital health tools might help to reduce the excess opioids on the market while ensuring that patients still get the pain control they need.