Title: Improving the Wellbeing of people with Opioid Treated CHronic pain – The I-WOTCH Study – recruitment so far and lessons learned

Conference:

SAPC ASM 2018 - London

Talk Code:

P1.83

Presenter:

H Sandhu

Twitter:

@DrHSandhu

Co-authors:

Authors: H. Sandhu, C. Abraham, S. Allyeyne, S, Balasubramanian, L. Betteley, S. Carnes, A. Furlan, K. Haywood, A. Hipwell, C. Iglesias Urrutia, R. Lall, J. Griffiths, A. Manca, S. Newton, J. Noyes, A. Rahman, K. Seers, J. Shaw, N. Tang, S. Taylor, C. Tysall, M. Underwood, S. Eldabe

Author institutions:

James Cook University Hospital, Queen Mary University of London, University of York, University College London, University/User Teaching and Research Action Partnership, University of Toronto, University of Exeter, University Hospitals Coventry and Warwickshire NHS Trust

Problem

The concern of increased prescribing and use of strong opioids for the management of chronic non-malignant pain continues to grow. Despite limited data supporting the effectiveness of long-term use, prescription data from the UK show substantial increases in the use of opioids for non-cancer pain with a 466% increase in the number of strong opioid users between 2000 and 2010. Recent guidelines published by the Faculty of Pain Medicine outline the risk of disabling symptoms linked to higher doses of morphine equivalent doses of opioid use and encourages the discontinuation if there is no impact on pain. However there little guidance/support for people wishing to reduce their intake of opioid use and manage their pain using alternative strategies.

Approach

The I-WOTCH study (a definitive multi-centre randomised controlled trial) will evaluate the effectiveness and cost effectiveness of a patient-centred multicomponent self-management intervention for people living with chronic non-malignant pain, that targets withdrawal of strong opioids on activities of daily living and opioid related adverse events. Those randomised to the I-WOTCH intervention receive a three day group facilitated course led by a trained nurse and a lay person with chronic pain and experience of opioid withdrawal/tapering. In addition, participants will also receive one-to one sessions (face to face and telephone with the trained nurse) to develop a tapering plan. Participants will also receive a copy of (My Opioid Manager (anglicised); a self-help guide for people using opioid drugs for chronic pain)). Those in the control intervention will receive (My Opioid Manager (anglicised) and a relaxation CD only. Participants are recruited from primary and secondary care as well as posters displayed in pharmacies. Eligibility criteria includes adults over the age of 18 years with non-malignant chronic pain and use of strong opioids as defined by the Faculty of Pain Medicine in the past three months and on most days in the previous month. Randomisation is stratified by geographical locality, baseline pain severity and baseline opioid use (morphine equivalent dose, 24 hour period). We present here an update on recruitment.

Findings

West Midlands: From a combined list size of 236,693 generated from 31 GP Practices initial expression of interest forms were sent to 2374 potential participants. Of those returned 155 were eligible and 100 participants randomised (updated data will be presented). Excess treatment costs have been secured in the North East of England and updated figures of recruitment will be presented. Data will be presented for mean age, base line opioid use, pain intensity as measured by the PROMIS 3a and pain interference as measured by the PROMIS 8A.

Consequences

We have demonstrated the feasibility of recruiting to a study of a group based intervention to help people come off opioid drugs used for chronic non-malignant pain.

Submitted by:

Harbinder Sandhu

Funding acknowledgement:

This project was funded by the National Institute for Health Research HTA Programme (project number 14/224/04)