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New trial to improve lives of long-term painkiller users

The University of Warwick in the UK is starting a trial to improve the lives of long-term strong painkiller users.

Researchers from the University’s Warwick Medical School and The James Cook University Hospital, Middlesbrough, have developed a support programme that they hope will help people with long term pain reduce their dependency on strong pain killers (opioids) and improve their quality of life.

The trial is being led by Dr Harbinder Sandhu, associate professor, Warwick Medical School, and Professor Sam Eldabe, consultant in pain medicine, The James Cook University Hospital. It is funded from The NIHR Health Technology Assessment Programme.

Dr Sandhu said: “Evidence suggests that opioids are only effective in the short term and patients take them long term then need to manage a range of side effects and can suffer devastating withdrawal symptoms.

However in the UK reports indicate that between 2000–2010 prescriptions of opioids for non-cancer pain increased by 466% and in 2015 there were 16 million opioid prescriptions costing over £200 million.

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

The study 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 developed at Warwick Medical School with input from the collaborative study team. Dr Sandhu and her team will measure the everyday functioning and opioid use of the 468 volunteers taking part in the study Called I-WOTCH (Improving the Wellbeing of People with Opioid Treated Chronic Pain). The intervention is targeting patients using strong pain killers up to and including Tramadol for the treatment of persistent non-cancer pain which account for 95 per cent of strong opioids prescribed in the UK within primary care.

Participants will be randomly divided into two groups: one will have access to the usual GP care plus an information booklet and a relaxation CD; the second will be given the same and also take part in a support programme led by a research nurse and a trained lay person who has chronic pain but has reduced their opioids intake. The course will include sessions such as coping techniques, stress management, goal setting, mindfulness, posture and movement advice, how to manage any withdrawal symptoms, and pain control after opioids.

Both groups will keep a diary for four months to provide important information about quality of life and any withdrawal symptoms and complete questionnaires about their everyday functioning and pain killer intake at interval’s throughout the trial.

Dr Sandhu added: “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”.

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. This is in spite of guidelines on the prescription of opioids being produced in many countries including the British Pain Society guidelines Opioids for Persistent Pain Good Practice.”

Professor Eldabe commented: “Our clinical experience of helping people who wished to come off strong pain killers 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 pain killers”.

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.