SMART Embedded Intervention for Military Postsurgical Engagement Readiness (SEMPER)

 

Project Description:

Knee osteoarthritis (OA) is one of the most common chronic overuse musculoskeletal disorders afflicting U.S. military service members and is among the primary conditions leading to medical separation from active-duty service. Given the magnitude and growth in knee OA prevalence, total knee arthroplasty (TKA) surgeries have surged to historic highs in recent years. Today, TKA is one of the most common inpatient surgeries performed in the U.S., but surgical outcomes can be highly variable and suboptimal. Even after a technically sound TKA, up to 25 percent of patients are dissatisfied with their surgical outcome, and many patients continue to experience prolonged pain and opioid use after surgery. In fact, TKA increases an opioid-naïve patient’s risk of developing chronic opioid use five-fold, and chronic opioid use leads to medical separation and undermines mission readiness across the Military Health System (MHS). Clearly, novel non-opioid pain management strategies are needed in the MHS. New scientific findings indicate that prolonged pain disrupts functioning in brain regions responsible for self-control, undermining patients’ ability to engage in effective self-management (i.e., self-regulation) of pain, and resulting in avoidance of physical activity, disengagement from physical therapy, and functional impairment. In the absence of effective self-regulation, patients become increasingly dependent on opioids for pain relief. Interventions are urgently needed to prevent TKA patients’ downward spiral into chronic pain, opioid dependence, and impaired musculoskeletal health. Unfortunately, standard of care during TKA does not address these factors, and current interventions often treat pain, addictive behaviors, and distress in isolation. To fill this gap, this study aims to conduct a pragmatic trial of a novel, adaptive therapeutic approach that integrates brief and intensive mindfulness-based interventions (MBIs) into surgical care pathways within the MHS and will be conducted in the standard clinical context at multiple military medical centers around the U.S., where behavioral health specialists will be trained to use evidence-based, manualized MBIs.

  

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For more information, contact utahpainstudy@utah.edu

 

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