17 December 2019
A pioneering pilot service set up in South Gloucestershire to review patients’ use of prescription opioid painkillers for long-term pain has helped many users reduce their use and improve their quality of life, researchers at the NIHR Health Protection Research Unit in Evaluation of Interventions and NIHR Applied Research Collaboration (ARC) West have found.
Long-term pain (also known as chronic pain) refers to pain that has lasted longer than three months.
GP prescriptions of opioid painkillers - such as morphine, tramadol and codeine - for people with long-term, non-cancer-related pain have increased by more than 60 per cent in the last 10 years but there’s little evidence that opioid painkillers are effective in treating this type of pain. Long- term use of opioid painkillers can also be associated with people becoming dependent on these painkillers and an increased risk of death from overdose.
The South Gloucestershire opioid and pain review service
The South Gloucestershire opioid and pain review service aimed to support long term users of opioid painkillers manage their pain in a GP setting and where possible, reduce their opioid use. The service ran for 24 months in two local GP practices.
Dedicated project workers provided each patient with an individually tailored pain-management plan which included setting daily goals, developing a relaxation strategy, introducing exercise and improving sleep. They reviewed the types and amounts of opioid that the patient was taking, and provided support, if appropriate, to help them reduce their dose.
Evaluating the service
Researchers who evaluated the service found that 35 per cent of patients who used the service reduced their opioid dose while a further nine per cent stopped taking opioids altogether. On average, service users improved on all health, well-being and quality of life outcome scales, but with no change in their pain relief scores.
Interviews with patients and service providers found that patients welcomed having time to discuss their pain, its management and related psychological issues. They also wanted a long-term approach, as long-term pain is a complex issue which takes time to address. They felt benefits of the service included improved wellbeing such as greater confidence and self-esteem, being able to use pain management strategies, changes in their use of medication and reductions in their dose.
Dr Jo Kesten, Senior Research Associate at the NIHR Health Protection Research Unit in Evaluation of Interventions at the University of Bristol and NIHR ARC West, said: "Our evaluation suggests this model of service may be a useful means to support patients with long-term non-cancer pain in primary care. Using qualitative as well as quantitative methods provided detailed insights into how patients experienced the service. Service users welcomed having time to discuss their pain, its management and related psychological issues with dedicated project workers. We need larger studies to build greater understanding of the type of support that can help improve the management of long-term pain conditions."
Lauren Scott, Senior Research Associate at the NIHR ARC West and a lead researcher, said: “Public Health England’s prescribed medicines review recommends improving support for patients on opioid painkillers to manage their pain more effectively and reduce the risk of developing dependence. Our evaluation of the pilot service in South Gloucestershire reinforces this recommendation and suggests that it is possible for patients with chronic pain on long-term opioids to be successfully managed in GP practices.
“Our findings highlight both the importance of the project worker and the value of running a flexible, individually tailored service. We evaluated a small group of patients, so larger studies are required to be sure of the effects. However, we hope our findings will inform the development of similar services in the future.”
Dr Kyla Thomas, Consultant Senior Lecturer in Public Health Medicine and NIHR Postdoctoral Fellow at the University of Bristol and Principal Investigator, said: “We welcome the recommendation in Public Health England’s prescribed medicines review related to improving the support available from the healthcare system for these patients. We agree that the NHS locally should work with local authorities to commission support for these patients, to develop a response that is informed by local needs and circumstances, and involves local primary care services, pain and addiction specialists and patient groups.”
Evaluation of a primary care-based opioid and pain review service: a mixed-methods evaluation in two GP practices in England by Lauren J Scott, Joanna M Kesten, Kevin Bache, Matthew Hickman, Rona Campbell, Antony E Pickering, Sabi Redwood and Kyla Thomas. Published in British Journal of General Practice. 2 December 2019.
Acceptability of a primary care-based opioid and pain review service: a mixed-methods evaluation in England by Joanna Kesten, Kyla Thomas, Lauren Scott, Kevin Bache, Matthew Hickman, Rona Campbell, Anthony Pickering and Sabi Redwood. Published in British Journal of General Practice. 8 October 2019.
About the NIHR HPRU in Evaluation of Interventions at the University of Bristol
The Health Protection Research Unit (HPRU) in Evaluation of Interventions, based in Population Health Sciences at the University of Bristol, is part of the National Institute for Health Research (NIHR) and a partnership between University of Bristol and Public Health England (PHE), in collaboration with University College London, Cambridge Medical Research Council (MRC) Biostatistics Unit and University of the West of England. We are a multidisciplinary team undertaking applied research on the development and evaluation of interventions to protect the public’s health. Our aim is to support PHE in delivering its objectives and functions. Our focus is on the PHE priority area of infection. Follow us on Twitter: @HPRU_EI
About the NIHR
The National Institute for Health Research (NIHR) is the nation's largest funder of health and care research. The NIHR:
- funds, supports and delivers high quality research that benefits the NHS, public health and social care
- engages and involves patients, carers and the public in order to improve the reach, quality and impact of research
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- partners with other public funders, charities and industry to maximise the value of research to patients and the economy.
The NIHR was established in 2006 to improve the health and wealth of the nation through research, and is funded by the Department of Health and Social Care. In addition to its national role, the NIHR commissions applied health research to benefit the poorest people in low- and middle-income countries, using Official Development Assistance funding.