Background & Aims

Despite the documented serious harms associated with long-term opioid treatment for Chronic Non-Cancer Pain (CNCP), many people remain on long-term opioid prescriptions. Current guidelines emphasise person-centred, non-pharmacological approaches and advocate for safe opioid reduction in patients no longer benefiting from opioid treatment. However, interventions to support these patients in primary care are limited. A Behavioural Intervention to Reduce Opioids (BIOR) was designed to facilitate safe opioid reduction for patients with CNCP in primary care, with the support of pharmacists. This study explores the feasibility of BIOR and examines the perspectives of patients and healthcare professionals in participating in the intervention. Additionally, the study aims to understand motivations, beliefs and experiences with opioid tapering, examining both successful and unsuccessful aspects of the intervention.

Methods

A qualitative study incorporating semi-structured interviews with healthcare providers and patients of NHS GP practices in Knowsley, UK. Seventeen interviews were conducted (n=11 patients, n=6 health professionals), and data is being analysed using Thematic Analysis.

Results

Results: Preliminary qualitative analysis revealed that patient readiness to change, support throughout the intervention, and the use of coping strategies appear to be determining experiences in their process to taper opioids in CNCP.

Conclusions

Managing pain and opioid tapering are critical elements for patients with CNCP and health care professionals in primary care. Results of this study show that patient readiness, sustained support, and coping strategies can influence a patient’s journey in tapering opioids within the BIOR pilot. Healthcare providers might be able to support their patients in weaning opioids by assessing patients’ readiness and motivations to and promoting the use of positive coping strategies.

References

Baldini, A., Von Korff, M., & Lin, E. H. B. (2012). A Review of Potential Adverse Effects of Long-Term Opioid Therapy: A Practitioner’s Guide. Primary care companion for CNS disorders, 14(3). https://doi.org/10.4088/PCC.11m01326
Bedson, J., Chen, Y., Hayward, R. A., Ashworth, J., Walters, K., Dunn, K. M., & Jordan, K. P. (2016). Trends in long-term opioid prescribing in primary care patients with musculoskeletal conditions: an observational database study. Pain, 157(7), 1525.
Chou, R., Turner, J. A., Devine, E. B., Hansen, R. N., Sullivan, S. D., Blazina, I., Dana, T., Bougatsos, C., & Deyo, R. A. (2015). The effectiveness and risks of long-term opioid therapy for chronic pain: a systematic review for a National Institutes of Health Pathways to Prevention Workshop. Annals of Internal Medicine, 162(4), 276-286.
Dowell, D., Haegerich, T. M., & Chou, R. (2016). CDC Guideline for Prescribing Opioids for Chronic Pain—United States, 2016. JAMA, 315(15), 1624-1645. https://doi.org/10.1001/jama.2016.1464
Dowell, D., Ragan, K. R., Jones, C. M., Baldwin, G. T., & Chou, R. (2022). CDC Clinical Practice Guideline for Prescribing Opioids for Pain – United States, 2022. MMWR. Recommendations and reports, 71(3), 1-95. https://doi.org/10.15585/mmwr.rr7103a1
Eccleston, C., Fisher, E., Thomas, K. H., Hearn, L., Derry, S., Stannard, C., Knaggs, R., & Moore, R. A. (2017). Interventions for the reduction of prescribed opioid use in chronic non-cancer pain. Cochrane database of systematic reviews, 11(11), CD010323-CD010323. https://doi.org/10.1002/14651858.CD010323.pub3
National Institute for Health and Care Excellence. Medicines optimisation in chronic pain. KTT21. London: NICE, 2017.

Presenting Author

Andreia Ramos Silva

Poster Authors

Andreia Ramos Silva

Liverpool John Moores University

Lead Author

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Helen Poole

Liverpool John Moores University

Lead Author

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Cathy Montgomery

PhD, BSc

Liverpool John Moores University

Lead Author

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Bernhard Exam

The Walton Centre NHS Foundation Trust, Liverpool, UK

Lead Author

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Aimee Woods

MSc

Liverpool John Moores University

Lead Author

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