5 Jun 2023 • A novel intervention that blends individualized care, mindfulness, and a tapering plan is more successful than usual care in helping patients discontinue opioids for chronic pain, new research shows. These findings were published online in the Journal of the American Medical Association. As part of the multisite Improving the Wellbeing of People with Opioid Treated Chronic Pain (I-WOTCH) study, 30% of participants in the intervention group were able to discontinue opioids vs 7% of those in the usual care group.

• Participants in the current study were taking opioids to relieve nonmalignant pain for at least 3 months and almost daily for at least a month before the study started. The medications included buprenorphine, morphine, fentanyl, methadone, oxycodone, and tramadol.
• Participants randomly assigned to receive usual care (n = 303) had access to their existing GP care and a self-help booklet on opioid management and a relaxation CD.
• The intervention participants (n = 305) received the same, plus a 3-day group meeting held once weekly by a nurse trained in the intervention, a mindfulness CD, and coaching on distraction techniques. In addition, participants received a 1-hour consultation with the nurse, two monitoring phone calls, an in-person consultation, and an individualized and flexible tapering plan.
• As part of the intervention, investigators reduced 10% of the baseline opioid dose each week until the participant reached 30% of the dose. They then reduced that dose by 10% each week. Participants were assessed every 4 months for a year.
• 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.

Source: JAMA| Read full story