Intervention for opioids appeared to reduce use, with no impact on pain
A trial in the U.K. randomly assigned patients with chronic noncancer pain to receive a group-based educational intervention or usual care and measured effects on opioid use and perceived pain at 12 months.
Group and individual support as well as skill-based learning significantly reduced patient-reported use of opioids compared with usual care, even though there appeared to be no effect on perceived pain and its impact on daily life activities, a study found.
Researchers in the United Kingdom conducted a pragmatic, multicentered, randomized 1:1 clinical trial among 608 participants who were taking strong opioids (buprenorphine, dipipanone, morphine, diamorphine, fentanyl, hydromorphone, methadone, oxycodone, papaveretum, pentazocine, pethidine, tapentadol, and tramadol) for chronic noncancer pain. They recruited participants from 191 primary care settings from May 2017 to January 2019 and assigned them to receive the intervention or usual care. Those assigned to the intervention attended three-day group sessions that emphasized skill-based learning and education and were offered individual support over the next year from a nurse and a layperson. The study's two primary outcomes were Patient-Reported Outcomes Measurement Information System Pain Interference Short Form 8a (PROMIS-PI-SF-8a) score (T-score range, 40.7 to 77, with 77 indicating worst pain interference; minimal clinically important difference, 3.5) and the proportion of participants who discontinued opioids at 12 months, measured by self-report. Results were published in the May 23/30 JAMA.
After a year of follow-up, 29% of people in the intervention group discontinued opioids versus 7% in the usual care group (absolute difference, 21.7% [95% CI, 14.8% to 28.6%]; P<0.001; odds ratio, 5.55 [95% CI, 2.80 to 10.99]). PROMIS-PI-SF-8a scores improved for both groups at 12-month follow-up (−4.1 in the intervention group vs. −3.17 in the usual care group), but there was no statistically significant between-group difference (mean difference, −0.52 [95% CI, −1.94 to 0.89]; P=0.15). Serious adverse events occurred in 8% of the participants in the intervention group and 5% of the participants in the usual care group. The most common serious adverse events were gastrointestinal (2% in the intervention group and 0% in the usual care group) and locomotor/musculoskeletal (2% in the intervention group and 1% in the usual care group). Four people (1%) in the intervention group experienced possible or probable symptoms of withdrawal (shortness of breath, hot flushes, fever and pain, small intestinal bleed, and an overdose suicide attempt).
Among the study limitations, opioid use was measured using self-report and was not validated with blood or urine samples, and participants volunteered and were likely committed to reducing their use of opioids, the researchers noted. “In this multicentered, randomized clinical trial, a group-based educational intervention that consisted of group and individual support as well as skill-based learning significantly reduced patient-reported use of opioids compared with usual care,” they wrote. “However, there was no effect on perceived pain interference with daily life activities at 12-month follow-up.”