Acceptability of a primary care-based opioid and pain review service: a mixed-methods evaluation in England

Background
Primary care opioid prescribing to treat chronic non-cancer pain (CNCP) has progressively increased despite a lack of evidence for long-term safety and effectiveness. Developing primary care interventions to reduce opioid dependence in CNCP patients is a public health priority.

Aim
We report the acceptability of the South Gloucestershire pain and opioid review service for CNCP patients which aimed to help patients understand their relationship with prescribed opioids and support non-drug-based pain management strategies.

Design and Setting
The service was based in two GP practices in South Gloucestershire and delivered by project workers. A mixed-methods evaluation was performed.

Method
Descriptive data were collected on delivered within-service and community-based interventions. Twenty-five semi-structured interviews (18 service-users, 7 service-providers) explored experiences of the service.

Results
The enrolment process, person-centred, primary care-based delivery and service content focused on psychological issues underlying CNCP were acceptable to service users and providers. Service users welcomed having time to discuss their pain, its management and related psychological issues. Maintaining a long-term approach was desired as CNCP is a complex issue which takes time to address. GPs recommended that funding is needed to ensure they have dedicated time to support a similar service and to ensure that project workers receive adequate clinical supervision.

Conclusion
This service model was acceptable and may be a useful means to manage patients with CNCP who develop opioid dependence after long-term use of opioids. A randomised controlled trial is needed to formally test the effectiveness of the service.