South Gloucestershire Opioid Pain Review Pilot study: a mixed methods evaluation

Jo Kesten, Lauren Scott, Kevin Bache, Rosie Collins, Sabi Redwood, Kyla Thomas

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Abstract

Background: Primary care can be an appropriate setting to address opioid analgesic dependence among patients with chronic non-cancer pain. This study evaluated the South Gloucestershire Opioid Pain Review Pilot which aims to help patients understand their relationship with opioids and to develop alternative, non-drug-based, pain management strategies.

Methods: Patients from two general practices in South Gloucestershire, UK, were invited to take part in the pilot (September 2016-October 2018). They were given an individually tailored intervention, based on the shared care model, and social prescribing including pain management, and referred to external services. Experiences of the pilot were explored with semi-structured interviews. Routine quantitative data were collected on demographics; opioid use and dose; wellbeing and quality of life; and pain intensity, pain relief, and interference with life. A mixed-methods approach supported a comprehensive evaluation of the pilot. Interviews were analysed thematically. Quantitative and qualitative data were integrated using “following a thread” and triangulation. The study was given ethics approval by West Midlands – Coventry and Warwickshire Research Ethics Committee, and participants gave written or verbal informed consent.

Findings: Of 59 invited patients, 34 (58%) enrolled into the service and contributed quantitative data. 18 of the 34 service-users and seven service providers were interviewed. On average, service-users showed improvement in all outcomes except pain relief from medication. Baseline opioid dose reduced at follow-up (median 90mg, IQR 60–240 vs 72mg, 30–160, Wilcoxon signed-rank test p=0·00013). Service-users received the pilot positively, valuing their relationship with the project worker, time to discuss pain management, and individually tailored support. Individual needs and readiness to change shaped responses to the intervention. Perceived benefits related to understanding of pain, wellbeing, and quality of life; pain management strategies; and medication changes.

Interpretation: This novel pilot has shown promise. We recommend that future initiatives within primary care are individually tailored. Project worker and service-user relationships are important. A randomised controlled trial is needed to test the impact of this care-pathway.
Original languageEnglish
Pages (from-to)s47
Number of pages1
JournalLancet
Volume392
Issue numberSupplement 2
Early online date22 Nov 2018
DOIs
Publication statusPublished - Nov 2018

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