EHR Pain Care Intervention Lowers Opioid Exposure but Not Pain Interference

An electronic health record (EHR)–embedded intervention promoting nonpharmacologic pain care (NPPC) lowered postoperative opioid exposure by approximately 10% but did not improve pain interference or physical function, according to a cluster randomized clinical trial published in JAMA Network Open.

The Non-pharmacological Options in Post-Hospital and Rehabilitation Pain Management (NOHARM) pragmatic, stepped-wedge trial (NCT04570371) was conducted from October 2020 through April 2024 at 22 surgical practices in 6 surgical centers in Minnesota, Wisconsin, Florida, and Arizona. The intervention included a Healing After Surgery guide delivered through the patient portal before surgery, clinical decision support prompting allied health staff to reinforce patients' NPPC choices, and NPPC education and self-management resources. The comparator was usual care.

Among 68,141 surgical procedures, 43,053 occurred during intervention periods and 25,088 during usual care periods. The co-primary outcomes, Patient-Reported Outcomes Measurement Information System (PROMIS) Pain Interference and Physical Function T scores, did not differ between periods (adjusted mean differences, 0.09 [P = .51] and 0.15 [P = .27], respectively). Total postoperative opioid exposure over 3 months was lower during intervention periods (rate ratio, 0.90; P = .03), corresponding to an adjusted mean difference of approximately 260 morphine milligram equivalents per patient.

The investigators reported that the reduction was driven primarily by lower in-hospital opioid administration. Opioid prescribing at discharge was also lower, whereas opioid administration and prescribing after the index hospitalization did not differ significantly. PROMIS Anxiety scores, health care utilization, opioid-related adverse events, and other monitored safety outcomes were similar between groups.

The authors noted that the trial was conducted within a single integrated health system using a common EHR platform, which may limit generalizability, and that the relative contribution of individual intervention components could not be determined. Participants, clinicians, and investigators were not blinded. The authors concluded that the findings suggest potential for scalable EHR-based strategies to support safer postoperative pain management.

Source: Cheville AL, Herrin J, Minteer S, et al. Integrating nonpharmacological options into perioperative pain care: a cluster randomized clinical trial. JAMA Netw Open. 2026;9(9):e2635900. doi:10.1001/jamanetworkopen.2026.35900