A programme of dose tapering, group meetings and alternative therapies to help people manage their pain can help one in five people quit opioid prescriptions in a year, researchers have reported.
And importantly participants did not report worse pain after coming off the drugs.
More than 600 people who had been taking strong opioids for at least three months took part in the randomised controlled trial through GP practices in the North East and Midlands.
Those who had the intervention received sessions on coping techniques, stress management, goal setting, mindfulness, posture and movement advice, how to manage any withdrawal symptoms and pain control after opioids.
After 12 months, 29% of those who had fully come off opioids compared with just 7% of patients who received usual GP care, a self-help booklet and relaxation CD,
There was no difference in the two groups in terms of their pain or how the pain interfered with their lives, the researchers reported in JAMA.
In March NHS England recommended that GPs should offer alternatives including psychotherapy, sleep clinics and social activities or clubs before prescribing addictive painkillers or antidepressants.
It came as data showed GPs and pharmacists have already helped cut opioid prescriptions by 450,000 in under four years.
The progress equated to an 8% drop and has been estimated to have saved nearly 350 lives and prevented more than 2,100 incidents of patient harm.
A review in 2019 found one in four adults in England were prescribed potentially addictive drugs.
Trial leader Professor Harbinder Kaur Sandhu from the University of Warwick, 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.
‘The findings from the trial are extremely promising. Many people who have been taking prescription painkillers over a long period time suffer with harmful side effects but can feel reluctant to come off them because they think it could make their pain worse, or they do not know how to approach this with their clinician.’
The intervention, which includes an 8-10 week course, was specifically designed to be safe, supportive and gradual while helping people to learn alternative ways to manage their pain and help overcome challenges of withdrawal, she added.
Study co-lead Professor Sam Eldabe consultant in pain medicine at The James Cook University Hospital, said the NIHR funded trial was the culmination of six years of work during which we learned that the harms from long term opioids extend beyond the individual into their social circle.
‘Despite appreciating the social impact of the drugs, most patients utterly dread a worsening of their pain should they attempt to reduce their opioids.
‘Our study shows clearly that opioids can be gradually reduced and stopped within no actual worsening of the pain. This confirms our suspicions that opioids have very little long-term impact on persistent pain.’
Good response to those who are motivated to quit and had help to do so via the I-WOTCH trial I suppose. We offered this trial to all our eligible patients on high dose steroids. Very few took it up in our practice.
The issue is many of those on high dose opioids with dependency do not want to quit or have other psychological issues which worsens their pain perception.
Also the state of pain clinics is appalling- I think PULSE reported an NHS director stating he does not refer to pain clinics as they are not helpful.
As the professor says “Structured, group-based, psycho-educational self-management interventions help people to better manage their daily lives with a long-term condition, including persistent pain”
– needs to be commissioned to help more people quit/reduce high dose opioids.