A randomized controlled trial at Temple University Hospital indicates that a mobile application, CPMRx, significantly reduces opioid misuse among women following cesarean section. The study, published in BMC Pregnancy and Childbirth, found a 92% reduction in the odds of opioid misuse in the group using the app compared to the control group. This suggests a promising role for mobile health technology in addressing the opioid crisis, particularly in postpartum pain management.
The research involved 100 participants undergoing cesarean sections, split into two phases. In Phase I, the control group received electronic monitoring blister packs, while the experimental group used the CPMRx app in conjunction with the blister packs. Phase II removed the blister packs to reduce the feeling of being monitored; the control group had a hard count of pills, and the experimental group used the app with the hard count. The primary outcome was the total number of prescribed opioids used, and the secondary outcome was opioid misuse, defined as use outside prescribed parameters.
Key Findings on Opioid Use and Misuse
Logistic regression analysis revealed a significant difference in opioid misuse between the groups (p = 0.007). Participants using the CPMRx app experienced a 92% reduction in the odds of opioid misuse (OR = 0.08, p = 0.03). Relative risk estimation showed that the control group had a seven times higher risk of opioid misuse (RR = 7.00, p = 0.05).
"Patients using CPMRx were significantly less likely to misuse their prescription opioids," the researchers noted. "Data suggest that scaling the use of CPMRx for all cesarean section cases would improve patient safety while maintaining effective pain control and patient satisfaction."
Implications for Prescribing Practices
The study also shed light on opioid prescribing practices. Among participants in Phase I who did not misuse opioids, the average number of pills used was 2.7 (SD = 3.5). 95% of patients used 8 or fewer pills, 90% used 6 or fewer, 75% used 4 or fewer, and half used 1 or fewer opioids. The standard prescription was 15 oxycodone tablets (5 mg).
Based on these findings, the researchers suggest that a prescription of 7 tablets of 5 mg oxycodone may be more appropriate for this patient population. "Given that 90% of participants in our study used 6 or fewer opioid pills, a conservative recommendation would be to reduce the standard to 7 tablets," the authors stated.
Study Limitations and Future Directions
The study acknowledges limitations, including attrition in the experimental group during Phase II and the study's focus on an inner-city, primarily Medicaid population, which may limit generalizability. Further studies involving a wider demographic are needed to validate the app's effectiveness in standardized care.
Despite these limitations, the study provides valuable insights into the potential of mobile health interventions to reduce opioid misuse and optimize pain management after cesarean section. The CPMRx app offers a promising tool for improving patient safety and addressing the broader opioid crisis.
