A fifth of patients stopped taking opioids for chronic pain after participating in group support sessions for a year, results of a clinical trial have shown.
Between 2017 and 2020, researchers at the University of Warwick and The James Cook University Hospital assigned 608 adults taking strong opioids, such as buprenorphine, dipipanone and morphine, to treat chronic pain into two groups, as part of the ‘Improving the Wellbeing of people with Opioid Treated Chronic Pain’ (I-WOTCH) study.
The first group was given access to their existing GP care, along with a self-help booklet and relaxation CD. The other group had access to the same care as the first, in addition to taking part in an intervention programme that included group sessions and 1-on-1 support, delivered by a nurse and lay person for 12 months.
The group sessions provided coping techniques, stress management, goal setting, mindfulness, posture and movement advice, as well as advice on how to manage any withdrawal symptoms and pain control after using opioids.
The randomised clinical trial, which was funded by the National Institute for Health and Care Research (NIHR) and published in JAMA on 23 May 2023, found that, after 12 months, 65 of 225 participants (29%) in the intervention group had stopped taking opioids, compared with 15 of 208 participants (7%) in the usual care group (odds ratio, 5.55 [95% confidence interval [CI], 2.80 to 10.99]; absolute difference, 21.7% [95% CI, 14.8% to 28.6%]; P < .001).
Results also showed that “there were no statistically significant differences in pain interference with daily life activities between the two groups at 12 months”, the study said.
“In people with chronic pain due to non-malignant causes, compared with usual care, a group-based educational intervention … reduced patient-reported use of opioids, but had no effect on perceived pain interference with daily life activities,” the researchers concluded.
The findings follow NHS England publishing a framework in March 2023 that recommended non-drug alternatives to antidepressants and opioids.
Roger Knaggs, associate professor in clinical pharmacy practice at the University of Nottingham and a specialist in pain management, said: “Opioids are effective medicines for some types of pain, including pain after an operation or in the last few days of life.”
However, he added that they “are much less effective for many people who have been taking them for other types of long-term pain, such as back and joint pain”.
“The I-WOTCH study is one of the largest studies investigating how best to work collaboratively with people prescribed opioids, who wish to reduce their dose. It has demonstrated that, with support, many people are able to stop taking opioids without affecting their pain intensity,” he said.
“The study demonstrates the importance of a holistic approach with group education sessions, including people with lived experience and an individualised tapering plan to improve the outcomes and success of the intervention.”
Knaggs added that “with so many people prescribed opioids in the UK and throughout the world, the results of the I-WOTCH study have the potential to influence clinical practice in this field”.
On 2 March 2023, NHS England announced that GPs and pharmacists have helped cut opioid prescriptions in England by 450,000 in “under four years”.
However, data also show that the number of people prescribed an opioid for longer than three months has not decreased since it accelerated during the COVID-19 pandemic (see Box).
Emma Davies, advanced pharmacist practitioner in pain management at Cwm Taf Morgannwg University Health Board, said: “The term ‘addiction’ is not especially helpful, as there are many reasons to reduce and stop opioids, and genuine addiction is rare; dependence, however, is more common.”
“I think this is an important step forward in terms of understanding how we can better support people to safely and effectively reduce medicines such as opioids, which cause significant harms in addition to their potential for dependence.
“Whilst some may consider no change in pain to be a negative for this study, it is quite common in long-term pain for people to make improvements in their function and quality of life whilst continuing to report pain. I would suggest this demonstrates the limitations of medicines to reduce pain despite causing detriment to people’s health and wellbeing.”
Box: The problem with high-dose opioids
Latest data show that the number of patients prescribed an opioid for more than three months has not reduced since the COVID-19 pandemic.
In June 2022, analysis of NHS Business Services Authority data, carried out by The Pharmaceutical Journal, showed that the number of patients in England prescribed an opioid for more than three months increased sharply during the COVID-19 pandemic.
The data show that 3,055 per 10,000 patients were prescribed an opioid for longer than three months between October and December 2019, compared with 3,918 per 10,000 patients for the same period in 2021.
However, the latest figures show that this number has continued to increase, with 3,945 per 10,000 patients prescribed an opioid for longer than three months between April and June 2022.