Can a multicomponent intervention consisting of group meetings, education, individual support, and skill-based learning reduce opioid use and improve pain interference with daily activities, compared with usual care?

To answer this question, researchers in the United Kingdom and Canada enrolled 608 participants (mean age 61 years, 60% female) with chronic pain due to nonmalignant causes. Participants were recruited from 191 primary care settings in a multicenter randomized clinical trial.

All patients had significant opioid use, including buprenorphine, dipipanone, morphine, diamorphine, fentanyl, hydromorphone, methadone, oxycodone, papaveretum, pentazocine, pethidine, tapentadol, and tramadol, with a daily median equivalent morphine dose of 46 mg. Patients were followed up for 1 year with a final check at 3 years.

Participants were randomized 1:1 to either usual care or 3-day-long group sessions that emphasized skill-based learning and education, supplemented by one-on-one support delivered by a nurse and lay person for 12 months.

The study looked at 2 main outcomes:

1. Patient-Reported Outcomes Measurement Information System Pain Interference Short Form 8a (PROMIS-PI-SF-8a) score (T-score range, 40.7-77; 77 indicates worst pain interference; minimal clinically important difference, 3.5).

2. The proportion of participants who discontinued opioids at 12 months, measured by self-report.

Of the 608 participants recruited, 440 (72%) completed the trial.

There were no statistically significant differences 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).

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.

There were no statistically significant differences in pain interference with daily life activities between the 2 groups at 12 months.

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 apparent symptoms of opioid withdrawal (shortness of breath, hot flushes, fever and pain, small intestinal bleed, and an overdose suicide attempt).

The authors concluded that in people with chronic pain due to nonmalignant causes, compared with usual care, a group-based educational intervention that included group and individual support and skill-based learning significantly reduced patient-reported use of opioids, but had no effect on perceived pain interference with daily life activities. (See Sandhu HK, Booth K, Furlan AD, et al. Reducing opioid use for chronic pain with a group-based intervention: a randomized clinical trial. JAMA. 2023;329(20):1745-1756. doi:10.1001/jama.2023.6454. Trial Registration http://isrctn.org Identifier: ISRCTN49470934.)