The Value of Healthcare Partnerships in innovating treatment for chronic pain

A healthcare partnership to help reduce the use of addictive opioid painkillers

Despite the health risks, long-term opioid use is common in the UK, with over one million people in England (2021) being prescribed opioids for more than three months. In 2023, the result from a ground-breaking research partnership, led by Professor Harbinder Sandhu, Warwick Medical School (WMS), with Professor Sam Eldabe, The James Cook University Hospital, Middlesbrough, showed that one in five patients remained opioid-free a year after following their innovative psycho-educational treatment.

Using pain management to taper the use of opioid painkillers

The impact of long-term opioid use extends beyond the individual patient, as they lose interest in social interactions with family and friends, and gradually withdraw from society into opioid dependency. Currently, there are no alternative treatments for managing chronic pain, or helping people safely reduce and come off opioids. With funding from the National Institute for Health Research (NIHR) the research partnership– called I-WOTCH (Improving the Wellbeing of people with Opioid Treated Chronic PainLink opens in a new window) –ran a five year trial to provide GPswith an evidence-based alternative to prescribing patients with opioids for chronic non-cancer pain.

Working with GPs to trial an approach to reducing opioid dependency.

Over five years the partnership developed the I-WOTCH treatment programme, engaging with 191 GP surgeries and recruiting 608 adults to the trial from the Midlands and Northeast England healthcare regions. Warwick Clinical Trials Unit (CTU) supported one of the largest randomised clinical trials in the UK, providing a facilitator manual to promote consistent delivery of the interventions, which were based on existing evidence from pain management and medication reduction programmes. Working with people who had experience of opioid use and chronic pain, the partnership designed and tested the programme of group sessions, plus one to one sessions focused on tapering the use of opioid drugs.

The significant impact of psycho-educational treatments

After a year, one in four people in the intervention group (29%) stopped opioids completely compared to just one in 14 (7%) in the control group, and yet there was no difference between the two groups in terms of their perception of pain or its impact on their lives. Managing chronic pain is not a one-size-fits-all solution and starting or changing treatments needs to fit in with life commitments and pressures. Many of the participants particularly valued seeing and hearing about other’s experiences of opioid dependency and tapering, and for one in four participants the programme proved to be a new way to manage chronic pain.

Piloting the treatment within the NHS

The next phase for this successful partnership is to work with NHS England's Medicine Safety Improvement Programme and pilot the I-WOTCH programme in a real-world setting with a few Integrative Care Boards (ICB) offering the programme. The research partners will deliver a three-day training programme for GPs and other clinicians within an ICB region, so they have the skills and resources needed to deliver the behaviour change intervention. The ambition is that when a patient seeks help for their chronic pain, or their current medication plan, then GPs are aware of a referral route to a regionally run I-WOTCH programme for treatment of chronic pain.

“In Canada, we are integrating the results of the i-Wotch trial into our clinical practice guidelines and educational tools for opioid prescribers. The I-wotch intervention showed that it is possible to reduce opioid doses among patients with chronic pain in a safe and effective way. 

Andrea Furlan MD PhD,Professor of Medicine, University of Toronto, Canada