A new treatment could help people to stop taking addictive opioid painkillers for chronic pain, research suggests.
Data suggests there are one million people at risk from longer-term continuous opioid prescriptions, and more than 50,000 have been taking these for six months or more.
This is at an estimated cost of £500 million to the NHS per year.
While recent NHS initiatives have managed to reduce opioid prescribing by 8%, saving an estimated 350 lives, the new research has found evidence that could help many more people stop their opioid painkiller use.
The findings from the trial are extremely promising— Harbinder Kaur Sandhu, University of Warwick
Opioids such as morphine, fentanyl and codeine are super strength medications for pain which can be highly addictive.
A team of researchers and doctors has developed and successfully trialled a programme designed to guide people in coming off prescription painkillers, tapering their opioid intake and learning how to manage their pain using alternative techniques with a course which combines one-to-one and group support.
According to the findings, after one year, one in five people were able to stop taking opioids without their pain increasing.
The scientists suggest the new treatment is an alternative to opioid use and has potential to give patients a better quality of life.
Harbinder Kaur Sandhu, professor of health psychology at the University of Warwick, who led the clinical trial, said: “Structured, group-based, psycho-educational self-management interventions help people to 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 findings from the trial are extremely promising.”
More than 600 people took part in the study between 2017 and 2020 who at the beginning of the trial had been regularly taking strong opioids for at least three months.
People were recruited from GP practices from the north-east of England and the Midlands.
Our study shows clearly that opioids can be gradually reduced and stopped within no actual worsening of the pain— Professor Sam Eldabe, The James Cook University Hospital
The study compared two treatments – existing GP care plus a self-help booklet and relaxation CD, versus the same with an intervention programme specially developed by the study team.
This 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.
According to the study, after one year, 29% of people who took part in the intervention programme were able to fully come off their opioids completely, compared with just 7% who were not involved in the programme.
Researchers say that many people who have been taking prescription painkillers over a long time suffer with harmful side effects.
However, they think it could make their pain worse, or they do not know how to approach this with their doctor, so they can be reluctant to come off the medication.
The findings suggest there was no difference between the two groups in terms of their pain, or how pain interfered with their lives.
Professor Sam Eldabe, clinical trial co-lead and consultant in pain medicine at The James Cook University Hospital, said: “Despite appreciating the social impact of the drugs, most patients utterly dread a worsening of their pain should they attempt to reduce their opioids.
“Our study shows clearly that opioids can be gradually reduced and stopped within no actual worsening of the pain.
I didn’t like being on tablets. They addled my brain, they made it difficult to think straight, my brain wasn’t functioning as it should— Colin Tysall, 81, from Coventry
“This confirms our suspicions that opioids have very little long-term impact on persistent pain.”
Colin Tysall, 81, from Coventry, was prescribed painkillers, including opioids, to treat chronic back pain, as a result of working lifting heavy parts as an aircraft radiologist for 30 years.
He said: “The treatment at the time was bed rest and painkillers. The tablets got stronger and stronger until eventually I was prescribed opioids.
“I didn’t like being on tablets. They addled my brain, they made it difficult to think straight, my brain wasn’t functioning as it should.
“I would have nightmares a lot. As soon as I could come off them, I did.”
After spending a decade visiting hospital to treat his back and mental health, Mr Tysall turned to alternative treatments to treat his pain, such as exercise, and mental health self-health groups.
Over a number of years he reduced his medication to a lower level, and was eventually able to come off the tablets altogether.
The findings are published in the Jama journal.
