In a groundbreaking clinical trial, a comprehensive treatment program combining one-to-one and group support sessions has shown remarkable success in helping individuals overcome their dependence on opioid painkillers without exacerbating their pain levels. Experts view this innovative treatment as a viable alternative to opioids, holding significant potential to enhance patients’ overall quality of life.
A team of scientists from the University of Warwick and The James Cook University Hospital in Middlesbrough spearheaded a clinical study funded by the National Institute for Health and Care Research (NIHR). This study focused on a novel treatment that could assist individuals in discontinuing their reliance on opioid painkillers for managing chronic pain.
Currently, more than 1 million people in the UK rely on prescription opioids, with over 50,000 individuals having used these drugs for six months or longer. This imposes a substantial financial burden on the National Health Service (NHS), with estimated annual costs skyrocketing to £500 million.
Recent NHS initiatives have successfully reduced opioid prescribing by 8%, potentially saving 350 lives.
New research has now surfaced, offering evidence that can help many more individuals break free from their dependence on opioid painkillers.
Despite the well-documented risks associated with long-term opioid use, there are currently no safe alternative treatments available for people dealing with chronic, non-cancer pain while attempting to taper off opioids.
To address this gap, a team of researchers and clinicians developed and tested an intervention program that guides individuals through the process of tapering their prescription painkiller intake, learning alternative pain management techniques, and receiving both group and one-to-one support.
One in five individuals successfully discontinued opioids within a year
The study, known as I-WOTCH (Improving the Wellbeing of People with Opioid Treated Chronic Pain), revealed that the intervention program enabled one in five participants to cease their opioid use entirely within one year, without resorting to substitute medications or experiencing an aggravation of their pain.
Over 600 individuals participated in this randomized controlled study conducted between 2017 and 2020. All participants had been regularly taking potent opioids for at least three months before the trial. They were recruited from GP practices located in the North East of England and the Midlands.
The study compared two treatment groups, with participants randomly assigned to each group. The first group received their usual GP care along with a self-help booklet and a relaxation CD. The second group received the same care but also participated in the specially developed intervention program designed by the study team.
The intervention program comprised sessions covering coping techniques, stress management, goal setting, mindfulness, posture and movement advice, managing withdrawal symptoms, and pain control after stopping opioid use.
Throughout the trial, participants completed questionnaires about their pain levels and everyday functioning at regular intervals.
After one year, 29% of those who underwent the intervention program successfully discontinued their opioid use, compared to only 7% in the group receiving usual GP care, the self-help booklet, and CD. Importantly, there was no discernible difference between the two groups in terms of pain intensity or its impact on daily life.
Combining group and one-to-one support for reduced opioid dependency
Professor Harbinder Kaur Sandhu, a Health Psychology expert from the University of Warwick and leader of the clinical trial, expressed optimism about the findings: “Structured, group-based, psycho-educational self-management interventions help people better manage their daily lives with long-term conditions, including persistent pain. However, few interventions have specifically targeted patients considering opioid withdrawal.”
“The trial results are highly promising,” Sandhu continued. “Many individuals who have been on prescription painkillers for extended periods often suffer from harmful side effects but hesitate to discontinue usage due to concerns about worsening pain or lack of guidance from their healthcare provider.”
“Our trial has identified a treatment that can aid individuals in safely and gradually tapering off opioids. It fosters a supported decision-making process between patients and clinicians, emphasizing the acquisition of alternative pain management strategies. This intervention has the potential to significantly improve overall quality of life.”
Opioids’ limited long-term impact on chronic pain
Professor Sam Eldabe, clinical trial co-lead and pain medicine consultant at The James Cook University Hospital, highlighted the significance of the findings: “Our trial is the culmination of six years of work, during which we discovered that the harms associated with long-term opioid use extend beyond the individual, impacting their social connections. Patients on opioids often lose interest in social interactions with family and friends, gradually withdrawing from society due to the mental fog induced by these medications.”
“Despite recognizing the social implications of opioids, most patients dread the prospect of increased pain should they attempt to reduce their opioid intake,” Eldabe explained.
“Our study unequivocally demonstrates that opioids can be gradually reduced and stopped without causing a worsening of pain. This confirms our suspicion that opioids have minimal long-term impact on persistent pain.”
Colin’s inspiring journey
Colin Tysall, an 81-year-old resident of Coventry, experienced chronic back pain after working as an aircraft radiologist for 30 years. His treatment included a succession of painkillers, including opioids.
“The treatment at the time involved bed rest and painkillers. The tablets became stronger and stronger until I was prescribed opioids,” Colin recounted.
The dependency on painkillers took a severe toll on Colin’s well-being: “I spent so much time in bed that I lost the use of my legs and fell into a deep depression, leading to a prescription for antidepressants. I couldn’t take care of my family, and at one point, I even contemplated suicide.”
Unsatisfied with the medication’s side effects, Colin decided to explore alternative treatments for his pain. “Exercise turned out to be the best treatment for me. I joined self-help groups for mental health, connecting with others facing similar challenges. We walked and talked together, which defied the conventional guidelines at the time. However, I found it helped distract me from the pain and made coping easier.”
Over a couple of years, Colin gradually reduced his medication until he was able to discontinue it entirely. Remarkably, he no longer experiences the debilitating pain he once endured.
Colin’s personal journey motivated him to retrain as an associate mental health manager. He now works at Coventry and Warwick universities, assisting in training psychiatric and nursing students.
More recently, Colin has been actively involved in supporting patients as a trained layperson in group support sessions for the I-WOTCH clinical trial at the University of Warwick’s Clinical Trials Unit.
The comprehensive intervention program consisted of an 8-to-10-week course, incorporating the following elements:
Group support sessions
The group sessions, led by a trained I-WOTCH nurse and a layperson with personal experience in pain and opioid tapering, consisted of three full-day sessions per week. They covered education about opioids and pain, case studies of successful tapering, self-management skills for pain, and challenging beliefs. Participants also had the opportunity to practice techniques such as mindfulness and distraction.
Tailored one-to-one support and opioid tapering
In addition to the group sessions, participants received individualized support and tailored advice for opioid tapering through face-to-face sessions and phone calls with the nurse. A tapering app specifically designed for the study was utilized to calculate the reduction in opioid intake based on current guidelines, which was implemented by the participants’ GPs.
Reference: “Reducing Opioid Use for Chronic Pain With a Group-Based Intervention” by Harbinder K. Sandhu, Katie Booth, Andrea D. Furlan, Jane Shaw, Dawn Carnes, Stephanie J. C. Taylor, Charles Abraham, Sharisse Alleyne, Shyam Balasubramanian, Lauren Betteley, Kirstie L. Haywood, Cynthia P. Iglesias-Urrutia, Sheeja Krishnan, Ranjit Lall, Andrea Manca, Dipesh Mistry, Sian Newton, Jennifer Noyes, Vivien Nichols, Emma Padfield, Anisur Rahman, Kate Seers, Nicole K. Y. Tang, Colin Tysall, Sam Eldabe, and Martin Underwood, 23/30 May 2023, JAMA.
Frequently Asked Questions (FAQs) about opioid painkiller dependence
What was the focus of the clinical trial mentioned in the text?
The clinical trial focused on testing a new treatment program that aimed to help individuals discontinue their reliance on opioid painkillers for managing chronic pain.
What were the findings of the clinical trial?
The trial found that one in five individuals were able to stop using opioids within one year without experiencing an increase in their pain levels. The intervention program, which combined one-to-one and group support sessions, proved to be successful in helping patients taper off opioids and learn alternative pain management techniques.
How many participants were involved in the clinical trial?
Over 600 people participated in the randomized controlled study conducted between 2017 and 2020. These individuals had been regularly taking strong opioids for at least three months prior to the trial.
Did the study compare different treatment approaches?
Yes, the study compared two treatment groups. One group received their usual GP care, along with a self-help booklet and relaxation CD. The second group received the same care and also participated in the intervention program specially developed by the study team.
Did the intervention program have a positive impact on opioid use?
Yes, the intervention program showed promising results. After one year, 29% of participants who underwent the program successfully discontinued their opioid use completely, compared to only 7% in the group receiving usual GP care, the self-help booklet, and CD.
Did the trial demonstrate any negative effects on pain levels?
No, there was no discernible difference between the two groups in terms of pain intensity or how pain interfered with their lives. The intervention program effectively helped individuals taper off opioids without worsening their pain.
What were the components of the intervention program?
The intervention program consisted of group support sessions and tailored one-to-one support. The group sessions covered education about opioids and pain, self-management skills, and techniques like mindfulness and distraction. The one-to-one support provided personalized advice for opioid tapering. Participants also received a tapering app designed for the study to assist in reducing opioid intake.
How were the participants recruited for the trial?
The participants were recruited from GP practices in the North East of England and the Midlands. They were individuals who had been regularly taking strong opioids for at least three months before the trial.
Were there any financial implications of opioid use addressed in the text?
Yes, the text mentions that prescription opioids currently cost the UK’s National Health Service (NHS) up to £500 million annually. The financial burden of opioid use highlights the importance of finding effective alternative treatments.
How did opioids impact patients’ quality of life?
Long-term opioid use was found to have negative impacts on patients’ quality of life. Patients on opioids often experienced harmful side effects and showed a reduced interest in social interactions, leading to withdrawal from society. The intervention program aimed to address these issues and improve patients’ overall well-being.
Can alternative treatments effectively manage chronic pain?
The study demonstrated that alternative treatments, including the intervention program, can be successful in helping individuals manage chronic pain without relying on opioids. The program focused on teaching participants alternative pain management techniques and supporting them in gradually tapering off opioids, resulting in improved pain management and quality of life.
More about opioid painkiller dependence
- University of Warwick: Link
- The James Cook University Hospital: Link
- National Institute for Health and Care Research (NIHR): Link
- NHS: Link
- JAMA Article: Link