In a trial of 608 U.K. participants with chronic pain from nonmalignant causes, a group-based intervention significantly reduced opioid use but not affecting perceived pain interference with daily life activities at 12 months compared with usual care. Group and individual support and skill-based learning were included in the intervention.
The multicentered, randomized clinical trial included adults at 191 primary care centers in England in 2017–19, with a final follow-up through Mar. 18, 2020. Participants were taking buprenorphine, dipipanone, morphine, diamorphine, fentanyl, hydromorphone, methadone, oxycodone, papaveretum, pentazocine, pethidine, tapentadol, or tramadol to treat chronic nonmalignant pain. They received usual care or 3-day–long group sessions emphasizing skill-based learning and education, supplemented by 1-on-1 support delivered by a nurse and layperson for 12 months.
Based on 2 primary outcomes of Patient-Reported Outcomes Measurement Information System Pain Interference Short Form 8a (PROMIS-PI-SF-8a) score and the proportion of self-reported participants who discontinued opioids at 12 months, the findings showed: “Of 608 participants randomized (mean age, 61 years; 362 female [60%]; median daily morphine equivalent dose, 46 mg [IQR, 25 to 79]), 440 (72%) completed 12-month follow-up. There was no statistically significant difference in PROMIS-PI-SF-8a scores between the 2 groups at 12-month follow-up (−4.1 in the intervention and −3.17 in the usual care groups; between-group difference: mean difference, −0.52 [95% CI, −1.94 to 0.89]; P = .15). At 12 months, opioid discontinuation occurred in 65 of 225 participants (29%) in the intervention group and 15 of 208 participants (7%) in the usual care group (odds ratio, 5.55 [95% CI, 2.80 to 10.99]; absolute difference, 21.7% [95% CI, 14.8% to 28.6%]; P < .001). Serious adverse events occurred in 8% (25/305) of the participants in the intervention group and 5% (16/303) 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 received additional medical care for possible or probable symptoms of opioid withdrawal (shortness of breath, hot flushes, fever and pain, small intestinal bleed, and an overdose suicide attempt).”
Related JAMA Clinical Guidelines Synopsis on Prescribing Opioids for Pain available online