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New NHS trial to look at reducing dependence on opioids

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A new trial is to look at a support programme designed to help patients with long-term pain reduce their dependency on strong opioid painkillers.

The study, funded by the NHS National Institute for Health Research, will assess a programme developed by the University of Warwick and James Cook University Hospital in Middlesbrough.

“Despite an overwhelming message of restraint, opioid prescribing continues to increase”

Harbinder Sandhu

It will be comparing two treatments – existing GP care, plus a self-help booklet and relaxation CD or GP care plus a specifically designed group and one-to-one support programme.

The support programme will be led by a research nurse and a trained lay person who has chronic pain but has reduced their opioids intake.

It will include sessions on coping techniques, stress management, goal setting, mindfulness, posture and movement advice, how to manage any withdrawal symptoms, and pain control after opioids

The intervention is targeting patients using painkillers up to and including tramadol for persistent non-cancer pain, which account for 95% of strong opioids prescribed in the UK within primary care.

Researchers will measure the everyday functioning and opioid use of over 450 volunteers taking part in the I-WOTCH – Improving the Wellbeing of People with Opioid Treated Chronic Pain – study.

Both groups will keep a diary for four months on quality of life and any withdrawal symptoms and complete surveys about their everyday functioning and painkiller intake at intervals during the trial.

“The great majority of patients who come off strong painkillers feel much better in themselves”

Sam Eldabe

The intervention will run in in three locations: North East England; North East London; and the West Midlands.

The 468 participants will be recruited from around 100 general practices, and from community pain/musculoskeletal services across the three locations.

The trial is being led by Dr Harbinder Sandhu, associate professor at Warwick Medical School, and Professor Sam Eldabe, consultant in pain medicine at South Tees Hospitals NHS Foundation Trust.

Dr Sandhu noted that opioids were only effective in the short term and those taking them routinely needed to manage a range of side effects and could experience “devastating withdrawal symptoms”.

“We hope that the results of our study will be used to help patients with long-term pain in the future,” she said.

“Structured, group-based, psycho-educational self-management interventions help people to better manage their daily lives with a long-term condition, including persistent pain, but few of these have specifically targeted patients considering opioid withdrawal,” she said.

She added: “There are substantial potential benefits to individuals and to the health and social care system from reducing opioid use. Despite an overwhelming message of restraint, opioid prescribing continues to increase.”

Dr Sandhu highlighted that reports indicated that during 2000-10 UK opioid prescriptions for non-cancer pain increased by 466% and in 2015 there were 16 million prescriptions costing over £200m.

Professor Eldabe said: “Our clinical experience of helping people who wished to come off strong painkillers is that the great majority feel much better in themselves, are better able to interact with their families, become more outgoing and active and perhaps surprisingly complain of no more pain than when they were taking the painkillers.”

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