Break free: New treatment helps people stop using addictive opioid painkillers

Addiction to opioid pain relievers

A landmark clinical study tested a program that included combined individual and group support sessions. It found that one in five individuals were able to stop using opioids without experiencing an increase in pain levels after one year. This new treatment option is considered an alternative to the use of opioids and, according to experts, has the potential to significantly improve patients’ quality of life.

Scientists from the University of Warwick and James Cook University Hospital in Middlesbrough have led a clinical study, funded by the National Institute for Health and Care Research (NIHR), into a new treatment that could help people stop relying on opioid painkillers for chronic pain management.

Prescription opioids are currently used by over 1 million people in the UK, with more than 50,000 of these people having used these medicines for six months or more. This imposes a significant financial burden on the NHS, with estimated annual costs reaching €500 million.

Recent NHS initiatives have succeeded in reducing opioid prescribing by 8%, saving around 350 lives.

New research has found evidence that it could help many more people stop using opioid pain relievers.

Despite evidence that long-term opioid use is harmful, there are currently no alternative treatments available to safely help people who are coming off opioids and are still coping with chronic non-cancer pain.

A team of researchers and physicians has developed and successfully piloted an intervention program designed to guide individuals to stop prescription painkillers, reduce opioid intake, and learn to manage pain using alternative techniques in a course that combines individual and group support.

1 in 5 people stopped taking opioids within a year

The study, titled I-WOTCH (Improving the Wellbeing of People with Opioid Treated Chronic Pain), found that the intervention program helped 1 in 5 people stop taking opioids within a year, without replacing their medications and without making their pain worse.

Between 2017 and 2020, more than 600 people took part in the randomized controlled trial who had been taking strong opioids regularly for at least three months at the start of the trial. Participants were recruited from general practice practices in North East England and the Midlands.

The study compared two treatments, dividing participants randomly into two groups. One group was given access to existing medical care, as well as a self-help booklet and relaxation CD; the second group had the same and also took part in an intervention program specially developed by the study group.

The intervention program included sessions on coping techniques, stress management, goal setting, mindfulness, posture and movement advice, how to manage any withdrawal symptoms, and pain control after opioids.

Participants filled out questionnaires about their daily functioning and interval pain reliever intake during the study.

After a year, 29 percent of people who took part in the intervention program were able to come off their opioids completely, compared with only 7 percent who were treated with their existing primary care physician, self-help booklet and CD.

There was no difference between the two groups in terms of pain or how the pain interfered with their lives.

Combined group and individual key support to reduce opioid need

Harbinder Kaur Sandhu, Professor of Health Psychology at the University of Warwickwho led the clinical trial, said: Structured, group-based, and psychoeducational self-management interventions help people 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 results of the trial are extremely promising. Many people who have been taking prescription pain relievers for a long time experience harmful side effects but may feel reluctant to stop taking them because they think it might make their pain worse or they don’t know how to discuss this with their doctor.

Our study found a treatment that could help people wean opioid-free, safely, supportively, and gradually. It is a supported decision between the patient and the doctor and not a forced reduction. The program helps people learn alternative ways to manage their pain and help overcome withdrawal challenges, and has the potential to give people an overall better quality of life.

Opioids have little long-term impact on chronic pain

Professor Sam Eldabe, clinical trial co-lead and pain medicine consultant at James Cook University Hospital, said: Our study is the culmination of six years of work during which we learned that the long-term harms caused by opioids extend beyond the individual in their social circle. Patients taking opioids lose interest in social interaction with family and friends and gradually withdraw from society into an opioid-induced mental fog.

Despite appreciating the social impact of medications, most patients fear that their pain will worsen if they try to cut back on their opioids.

Our study clearly shows that opioids can be gradually tapered and stopped without actual pain worsening. This confirms our suspicions that opioids have very little long-term impact on persistent pain.

Colin’s story

Colin Tysall, 81 from Coventry, has been prescribed painkillers including opioids to treat chronic back pain, after working as an aerial radiologist for 30 years.

I was an industrial radiologist and wasted my back X-raying aircraft parts and handling heavy castings for jet engines. The castings could weigh up to 200 pounds and even though we moved some of the castings to distilleries, it was still an effort. We had to move these castings very carefully, without lifting equipment.

Colin started experiencing sciatic pain down both legs and discovered he had three herniated discs in his back. He describes the devastating impact of painkiller addiction:

Treatment at the time was bed rest and painkillers. The tablets got stronger and stronger until I was finally prescribed opioids, Colin said.

I spent so much time in bed that I lost the use of my legs and fell into a deep depression, so I was also prescribed antidepressants. I couldn’t take care of my family and at one point I tried to take my own life.

I didn’t like being on tablets. They messed up my brain, made it hard for me to think straight, my brain wasn’t working as it should. I would have many nightmares. As soon as I could get them off, I did.

After spending 10 years visiting a hospital for back and mental health treatments, Colin turned to alternative treatments for his pain.

I found that the best treatment for me was exercise. I have been involved in mental health self-health groups and have become friends with people who have similar issues. We walked and talked together, which was the opposite of guidelines at the time, but I found it helped take my mind off the pain and made it easier to cope.

After spending a couple of years reducing his meds to a low level, Colin was eventually able to come off the tablets altogether. He recently discovered that he no longer suffers from pain.

Colin has retrained as Associate Director of Mental Health and continues to work at Coventry and Warwick Universities helping train psychiatry and nursing students.

Most recently, Colin has been involved with the University of Warwicks Clinical Trials Unit and has helped support patients in I-WOTCH Clinical Trials Group Support Sessions as an I-WOTCH trained layperson.

The comprehensive intervention program consisted of an 8 to 10 week course and included:

Group sessions consisted of three full-day sessions per week. Group sessions included opioid and pain education, case studies of people who cut successfully, learning self-management skills for pain, and challenging beliefs. There was also the opportunity to practice techniques like mindfulness and distraction. Group sessions were facilitated by a trained I-WOTCH nurse and a trained I-WOTCH layperson (someone who has had personal experience with pain and opioid tapering).

  • Tailored one-to-one support and opioid reduction

In addition to the group sessions, people in the study also received one-on-one sessions with the nurse to offer support and, importantly, tailored advice for opioid tapering which was provided face-to-face and via telephone calls. A reduction app designed for the study was used to calculate a reduction in opioid intake based on current guidelines at the time and implemented by the participants’ physicians.

Reference: Reducing Opioid Use for Chronic Pain in a Group Intervention by Harbinder K. Sandhu, Katie Booth, Andrea D. Furlan, Jane Shaw, Dawn Carnes, Stephanie JC Taylor, Charles Abraham, Sharisse Alleyne, Shyam Balasubramanian, Lauren Betteley, Kirstie L. Haywood, Cynthia P. Iglesias-Urrutia, Sheeja Krishnan, Ranjit Lall, Andrea Manca, Dipesh Mi stry, Sian Newton, Jennifer Noyes, Vivien Nichols, Emma Padfield, Anisur Rahman, Kate Seers, Nicole KY Tang, Colin Tysall, Sam Eldabe and Martin Underwood, May 23/30, 2023, JAMA.
DOI: 10.1001/jama.2023.6454

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