CBT intervention with yoga and education components improved pain management for patients on long-term opioids better than usual care

1. Cognitive behavioral therapy intervention with yoga and education components improved pain management for patients on long-term opioids better than usual care

Abstract: https://www.acpjournals.org/doi/10.7326/M21-1436  

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A pragmatic randomized controlled trial comparing pain-related outcomes for patients with chronic pain receiving long-term opioid therapy found that patients who received cognitive behavioral therapy (CBT) in their treatment plans reported improvements in self-reported pain and greater reductions in pain impact after one year. The findings are published in Annals of Internal Medicine.

Long-term opioid use targeting chronic pain can be associated with significant adverse health outcomes. Alternative approaches to chronic pain management have been extensively studied in patients with specific types of chronic pain in specialty settings. However, this study is the first examination of alternative treatments for broad chronic pain who were being treated with opioids in a primary care setting.

Researchers from Kaiser Permanente Washington Health Research Institute randomly assigned 850 adult patients taking long-term opioid therapy for chronic pain to receive either usual care (n=417) or a CBT intervention (n=433) embedded in primary care. Frontline clinicians delivered the intervention that included talk therapy and yoga-based adaptive movement.  The patients were assessed quarterly over 12 months for self-reported measures of pain and disability. The researchers found that patients receiving CBT had greater reductions in pain impact and pain-related disability compared to the usual care group. In addition, one in four patients receiving CBT reported more than 30 percent reductions in pain compared to similar reports from one in six patients receiving usual care. Patients in the CBT intervention group showed greater reduction in benzodiazepine use but there was no impact on opioid usage in either group.

Although effects of the intervention were modest, they persisted after treatment through final 12-month follow-up. Given the limited efficacy and safety of long-term opioid treatment of chronic pain and increasing demand for nonpharmacologic treatment, the researchers believe that this type of intervention may be an attractive option.

Media contacts For an embargoed PDF, please contact Angela Collom at acollom@acponline.org. To speak with the lead author, Lynn DeBar, PhD, MPH, please contact Caroline Liou at Caroline.X.Liou@kp.org.

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2. NIH summarizes exiting knowledge and unanswered questions about anti-SARS-CoV-2 antibodies

Abstract: https://www.acpjournals.org/doi/10.7326/M21-3669              

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Anti-SARS-CoV-2 antibodies have been used in health care and clinical settings to prevent and treat COVID-19. This summer, the National Institutes of Health (NIH) convened a virtual summit to summarize existing knowledge and identify key unanswered scientific questions about these antibodies. An article summarizing the discussion is published in Annals of Internal Medicine.

During the summit, presenters and expert panelists highlighted advances that have been made using anti-SARS-CoV-2 antibodies for prevention and treatment of COVID-19. To date, the U.S. Food and Drug Administration (FDA) has issued an approval for one antiviral drug to treat hospitalized patients and granted Emergency Use Authorizations (EUAs) for several single and combination monoclonal antibodies (mAbs) to treat persons in the outpatient setting. The experts also discussed ongoing studies to determine the potential benefit of high-titer convalescent plasma (CP) antibodies or hyperimmune globulin (HIG). Like mAbs, these CP and HIG antibodies have shown benefit in some instances when administered early.

Results in outpatients were more encouraging, according to the experts. In one trial, patients taking the mAb combination bamlanivimab-etesevimab had a 70 percent reduction in rates of hospitalization or death compared with placebo. As preventive therapy, mAbs could offer immediate protection for unvaccinated persons exposed to SARS-CoV-2 or those who have no specific exposure but work in high-risk settings. They could also be administered to the rare patient who cannot be vaccinated due to allergic reactions to components of the vaccine.

The experts also discussed several areas where knowledge gaps exist and how to address them. One important area of study is alternate routes of administration for mAbs and the potential effects of mAb infusions on COVID-19 vaccine immunogenicity. Several studies addressing these scientific questions (or knowledge gaps) are ongoing. According to the authors, the continuing emergence of SARS-CoV-2 variants underscores the critical need to identify classes of mAbs that can be successfully and effectively combined and to develop and evaluate broadly neutralizing antibody cocktails and bispecific antibodies to treat and prevent COVID-19.

Media contacts: For an embargoed PDF, please contact Angela Collom at acollom@acponline.org. Submit media request to NIAID Media Inquiries at mediainquiries@niaid.nih.gov.

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3. Study finds that nearly a third of Medicare recipients now see 5 or more physicians each year

Over the past 20 years, the number of physicians with whom PCPs must coordinate care for Medicare patients has increased by 83 percent

Abstract: https://www.acpjournals.org/doi/10.7326/M21-1523              

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A new twenty-year study of Medicare recipients reveals that a larger number of Medicare patients are making more appointments with a larger number of specialists each year while engagement with primary care physicians failed to change. The study describes changing trends in medical care systems over the previous two decades and the implications these trends have for the future of primary and specialty care physicians in the United States. The findings are published in Annals of Internal Medicine.

The dominance of specialty care in American medical care systems have drawn concerns about fragmentation of care and ballooning health care costs with a high burden on primary care physicians (PCP) coordinating patient care.

Researchers from Harvard T.H. Chan School of Public Health analyzed Medicare claims made between 2000 and 2019, reviewing a data increase from 6,140,952 to 7,165,513 beneficiaries, respectively. The data showed that mean number of PCP office visits annually per beneficiary did not meaningfully increase, but the mean number of unique PCPs seen annually increased by 36%. At the same time, the mean number of specialist physician office visits annually increased by 20.3% and the mean number of unique specialist physicians seen annually increased by 34.2%. Researchers found that, as of 2019, 30.1% of Medicare recipients saw five or more physicians annually. According to the data, these changes mean that the number of other physicians with whom PCPs must coordinate care for Medicare patients has increased by 83 percent. Simultaneously, researchers learned that one third of Medicare patients do not utilize a PCP to coordinate their care at all. The research team contributes these trends to the increasing number of distinct medical subspecialties, changes in medical care systems, and decline in the availability and widespread use of PCPs across the United States.

Media contacts: For an embargoed PDF, please contact Angela Collom at acollom@acponline.org. To speak with corresponding author, Michael L. Barnett, MD, MS, please contact Todd Datz at tdatz@hsph.harvard.edu.

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4. Researchers suggest building a national biorepository infrastructure to prepare for future pandemics

Abstract: https://www.acpjournals.org/doi/10.7326/M21-2857             

Editorial: https://www.acpjournals.org/doi/10.7326/M21-4145              

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Researchers from Boston Medical Center (BMC), a safety-net hospital in Boston, MA, recognized the importance of creating a COVID-19 biorepository to both support critical science and ensure representation in research for its urban patient population, most of whom are from underserved communities. The team describe their decision to build a hospital-wide biorepository for COVID-19 research samples and share challenges they overcame to coordinate the biorepository’s management with patients, researchers, and care teams. They call on hospital research teams, funders, policymakers, and infectious disease and public health communities to support biorepository implementation as an essential element of future pandemic preparedness. The paper is published in Annals of Internal Medicine.

The researchers describe how they created a biorepository that was inclusive of their patient population: largely non-White, lacking sufficient insurance, low income, no or limited English proficiency, and disproportionately at risk of COVID-19. Their centralized biorepository resulted in 48,000 samples from more than 10,000 patients, requiring adapting sample collection and lab logistics to prioritize safety and longevity, balancing research and clinical care, and creating a fee system for using samples to reduce costs. The researchers suggest that nationwide infrastructure and funding is necessary to support other hospitals and communities in preparation for the next pandemic.

Media contacts: For an embargoed PDF, please contact Angela Collom at acollom@acponline.org. To speak with corresponding author, Nahid Bhadelia, MD, MALD, please contact Erica Augustine, Communications & Outreach Associate at Center for Emerging Infectious Diseases Policy & Research (CEID) at erica@bu.edu.

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