PROJECT SUMMARY: Perioperative prescription of opioids is an important contributor to the current opioid epidemic, affecting ~4% of >50 million Americans undergoing surgery each year. The dose and duration of treatment of opioid in surgical patients is an established risk factor of opioid use disorder and overdose deaths. Although legislation and guidelines have been developed to limit the quantity of opioids prescribed following surgery in the US, in 2020, the number of opioid overdose deaths increased by 39% with worsening mental health and opioid use disorder in the context of COVID-19. Developing alternative and effective surgical analgesia and techniques to avoid or minimize the perioperative opioid use and opioid use disorder are critical in the fight of the current opioid epidemic. Auriculotherapy, a form of acupuncture, is an effective opioid-sparing alternative to treat pain. Use of traditional auriculotherapy is limited because the long and specific training requirement. Recently, a novel battery-powered and disposable auriculo-nerve field stimulator, NSS-2 Bridge Device® (NBD®), has been developed to overcome the limitations of the traditional auriculotherapy. NBD® is a disposable device that stimulates the branches of cranial nerves and of the superficial cervical plexus innervating the ear. The device has been cleared by the FDA to treat opioid withdrawal symptoms which includes abdominal pain and anxiety. The NBD® requires minimal training and allow to stimulate the auricular nerves for 5 days making NBD® a potential groundbreaking non-pharmacological approach to limit opioid use and prescription. Rodent studies are supportive of the NBD modulating pain pathways and decreasing inflammatory abdominal pain. Our human surgical pain pilot data is supportive that NBD® was effective in reducing postoperative opioid requirement in adults undergoing open surgery, especially in vulnerable older patients (>65 years). Our central hypothesis is that compared to a placebo, the NBD® will be an effective opioid-sparing tool in patients undergoing open surgery, and that the effectiveness of the NBD would be greater in vulnerable geriatric patients (age >65 years). Since, anxiety, depression, and catastrophizing increase post-operative pain and opioid requirement by up to 50% and since auriculotherapy reduces psychological symptoms, we also hypothesized that using NBD® will also reduce anxiety, depression and catastrophizing and that represents a mechanism by which NBD® reduce perioperative opioid requirements. Our multidisciplinary team is well positioned to test the following specific aims: 1) Quantify the opioid sparing property of NBD® following open surgery in vulnerable geriatric patients in a randomized, blinded, placebo-controlled clinical trial, 2) Evaluate the efficacy of NBD® in reducing postoperative depression, anxiety and catastrophization, and 3) Determine the effects of NBD® on the relationship of the postoperative psychological scores and opioid consumption. This research is expected to improve surgical pain relief, safety of postoperative opioids while minimizing opioid use, dependence, and risk of OUD in millions of Americans who have painful surgeries each year.

Project Narrative Excessive use of prescribed opioids during and after major surgery is a significant contributor to persistent opioid use, misuse and ongoing opioid epidemic, which are recently worsened by the pandemic. The proposed research has significant public health relevance because it aims to reduce surgical pain and opioid use with a promising non-pharmacological tool, Auriculotherapy, that stimulates ear nerves. By proactively reducing surgical pain, postoperative opioid use and opioid-related serious adverse effects with Auriculotherapy, this research will enable the best-in-class post-surgical pain and opioid-related outcomes in millions of Americans undergoing painful surgeries every year while minimizing the nation’s opioid epidemic burden.