Background & Aims

A randomised controlled trial (I-WOTCH)[1,2] found that a complex intervention which supported the tapering of strong opioids for chronic non-malignant pain was effective in helping people reduce or stop opioid use, without impacting on pain related disability. We report an embedded process evaluation of this intervention.
This process evaluation[3,4] aimed to explore the experiences of being in the I-WOTCH study for both patients and for those delivering the intervention.

Methods

We recruited participants with chronic non-malignant pain who were 18 years or older from general (family) practices in England who had been using strong opioids for at least 3 months on most days. We undertook semi-structured interviews with 20 intervention and 20 control participants and 18 intervention facilitators. Data were analysed using Framework Analysis. Fidelity was assessed.

Results

Four overarching themes emerged: the right time to taper; the backdrop of a life with chronic pain: needing support, and the benefits of being in a group. Those delivering the intervention reported three characteristic responses to the intervention: resistance, open to trying, and feeling it was not the right time. Being in a group was seen as providing people with somewhere to learn about the current thinking on opioid usage and its effects and explore how reducing opioids might work for them. Delivery fidelity was good with 83% adherence and 79% competence across a range of intervention groups.

Conclusions

The I-WOTCH intervention was useful for most interviewees. Being “the right time” to taper and having support emerged as important factors within the context of a complex life with chronic pain.

References

1) Sandhu HK, Abraham C, Alleyne S, Balasubramanian S, Betteley L, Booth K, Carnes D, Furlan AD, Haywood K, Iglesias Urrutia CP, Lall R, Manca A, Mistry D, Nichols VP, Noyes J, Rahman A, Seers K, Shaw J, Tang NKY, Taylor S, Tysall C, Underwood M, Withers EJ, Eldabe S. (2019) Testing a support programme for opioid reduction for people with chronic non-malignant pain: the I-WOTCH randomised controlled trial protocol. BMJ Open. 9(8):e028937. doi: 10.1136/bmjopen-2019-028937
2) Sandhu HK, Booth K, Furlan AD, Shaw J, Carnes D, Taylor SJC, Abraham C, Alleyne S, Balasubramanian S, Betteley L, Haywood K, Iglesias-Urrutia CP, Krishnan S, Lall R, Manca A, Mistry D, Newton S, Noyes J, Nichols V, Padfield E, Rahman A, Seers K, Tang NKY, Tysall C, Eldabe S, Underwood M (2023), Reducing opioid use for chronic pain with a group based intervention: a randomised clinical trial. JAMA. 329(20):1745–1756. doi:10.1001/jama.2023.6454
3) Nichols V, Abraham, C. Eldabe, S. Sandhu, H. Underwood, M Seers, K (2019). Process evaluation protocol for the i-wotch study: an opioid tapering support programme for people with chronic non-malignant pain. BMJ Open. 9:e028998. doi:10.1136/ bmjopen-2019-028998
4) Nichols VP, Abraham C, Eldabe S, Sandhu HK, Underwood M, Seers K; (2023) I-WOTCH team. ‘It was a joint plan we worked out together’. How the I-WOTCH programme enabled people with chronic non-malignant pain to taper their opioids: a process evaluation. BMJ Open. 2023 Dec 6;13(12):e074603. doi: 10.1136/bmjopen-2023-074603. PMID: 38056940; PMCID: PMC10711817.

Presenting Author

Kate Seers

Poster Authors

Kate Seers

BSc PhD DSc RN

University of Warwick

Lead Author

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Harbinder Sandhu DHealthPsy

University of Warwick, Warwick Medical School

Lead Author

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Martin Underwood MD

University of Warwick, Warwick Medical School

Lead Author

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Charles Abraham PhD

School of Psychology, Deakin University

Lead Author

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Sam Eldabe

The James Cook University Hospital, Middlesbrough, UK

Lead Author

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Vivien Nichols MSc

University of Warwick, Warwick Medical School, UK

Lead Author

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Topics

  • Evidence, Clinical Trials, Systematic Review, Guidelines, and Implementation Science