Preoperative Opioid Tapering Before Spine Surgery
A Pilot Study of the Feasibility of Preoperative Opioid Tapering Before Spine Surgery Using Cognitive Behavioral Therapy and Measuring Postoperative Outcomes
Thomas Jefferson University
45 participants
Dec 1, 2025
INTERVENTIONAL
Conditions
Summary
This is a pilot study in which patients taking opioids chronically who are scheduled for spine surgery at least 4 weeks in advance will be randomly assigned to one of two groups: opioid tapering with education alone or opioid tapering with education plus cognitive behavioral therapy (CBT). The primary objective is to determine the proportion of each group that is successful in achieving their opioid tapering goals by the time of surgery.
Eligibility
Inclusion Criteria4
- at least 18 years old
- scheduled for major spine surgery (i.e. at least 2 levels of fusion) with hospital admission of at least one night
- scheduled for spine surgery at least 4 weeks ahead of time
- takes between 40 and 200 oral morphine equivalents daily
Exclusion Criteria4
- inability to use a computer or tablet for telemedicine encounters
- non-English-speaking
- inability to complete assessments
- positive screen on the Columbia Suicide Screening Assessment
Interventions
Patients in the opioid tapering plus CBT group will set up an initial meeting with the pain physician within a few days of enrollment to set the tapering schedule. They will also have two CBT appointments set up to complete via telemedicine during the time between enrollment and surgery.
Patients in this group will be instructed to continue their opioids at the same doses and frequencies they were taking up through the day of surgery. They will set up an initial meeting within a few days of enrollment with the chronic pain physician to determine the tapering schedule which will occur over 4 weeks or more leading into surgery. The patient and pain physician will collectively agree on a tapering schedule.
Locations(1)
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NCT07221786