South Gloucestershire Opioid Pain Review Pilot study: a mixed methods evaluation

Abstract

Background Primary care can be an appropriate setting to address opioid analgesic dependence among patients with chronic non-cancer pain. This study evaluated the South Gloucestershire Opioid Pain Review Pilot which aims to help patients understand their relationship with opioids and to develop alternative, non-drug-based, pain management strategies. Methods Patients from two general practices in South Gloucestershire, UK, were invited to take part in the pilot (September 2016-October 2018). They were given an individually tailored intervention, based on the shared care model, and social prescribing including pain management, and referred to external services. Experiences of the pilot were explored with semi-structured interviews. Routine quantitative data were collected on demographics; opioid use and dose; wellbeing and quality of life; and pain intensity, pain relief, and interference with life. A mixed-methods approach supported a comprehensive evaluation of the pilot. Interviews were analysed thematically. Quantitative and qualitative data were integrated using "following a thread" and triangulation. The study was given ethics approval by West Midlands-Coventry and Warwickshire Research Ethics Committee, and participants gave written or verbal informed consent. Findings Of 59 invited patients, 34 (58%) enrolled into the service and contributed quantitative data. 18 of the 34 service-users and seven service providers were interviewed. On average, service-users showed improvement in all outcomes except pain relief from medication. Baseline opioid dose reduced at follow-up (median 90mg, IQR 60-240 vs 72mg, 30-160, Wilcoxon signed-rank test p=0•00013). Service-users received the pilot positively, valuing their relationship with the project worker, time to discuss pain management, and individually tailored support. Individual needs and readiness to change shaped responses to the intervention. Perceived benefits related to understanding of pain, wellbeing, and quality of life; pain management strategies; and medication changes. Interpretation This novel pilot has shown promise. We recommend that future initiatives within primary care are individually tailored. Project worker and service-user relationships are important. A randomised controlled trial is needed to test the impact of this care-pathway.

Opioids: what can be done about long-term prescribing?

“…As a result of the call for papers and literature search a total of 4 articles describing a total of 7 services, were included within the review. [111][112][113][114] Three of the included services were specific to opioid use. The remaining 4 covered a mixture of prescription drugs including benzodiazepines, z-drugs and antidepressants.…”

“…The limitations in the evidence mean it is not possible to make any firm conclusions on the effectiveness of current practice examples within the UK, and the studies included gave only limited insight into the effectiveness of existing UK services for prescribed medication dependence in terms of patient outcomes and the cost of these services. Although all of the studies that reported on reduction in dose/cessation of prescribed drugs indicated that a certain proportion of service users did benefit from the services in terms of reducing dose/ceasing use completely, [112][113][114] the proportion benefitting varied across individual services, the period over which data was collected was short, or data were collected from a small number of participants relative to the population served.…”

“…Opioid reduction/withdrawal services within the UK Two conference posters were included in the review. 112,114 One 112 described an existing opiate reduction service that had been developed within a primary care practice and the other 114 described a pilot intervention performed across 2 GP practices that aimed to help patients understand their relationship with opioids and develop non-drug-based methods of managing pain. Information concerning the components of the services was very limited and reporting of the outcomes was brief however both reported that a proportion of service users were able to completely cease opioids or reduce their dose.…”

“…Information concerning the components of the services was very limited and reporting of the outcomes was brief however both reported that a proportion of service users were able to completely cease opioids or reduce their dose. One 112 reported that 28% of participants were able to cease use of opioids and 70% significantly reduced their dose over 2 months, while the other 114 indicated that 44% (15 out of 34) service users reduced their dose of opioids over an unreported period of time, including 3 (9%) who ceased use completely. The same study 114 reported improvements in Current Opioid Misuse Measure (COMM) scale score, Brief Pain Inventory (BPI) severity and interference, Warwick-Edinburgh mental wellbeing scale and TOP quality of life scores (overall, physical and psychological), but a worsened percentage pain relief score, at follow-up compared with baseline although the length of follow-up was unclear.…”