I-WOTCH
Trial question
What is the role of group-based educational intervention in patients taking strong opioids for chronic nonnmalignant pain?
Study design
Multi-center
Open label
RCT
Population
Characteristics of study participants
60.0% female
40.0% male
N = 608
608 patients (366 female, 242 male).
Inclusion criteria: adult patients taking strong opioids to treat chronic nonmalignant pain.
Key exclusion criteria: people living in chronic care facilities; unable to leave home without assistance; use of methadone not prescribed for chronic pain.
Interventions
N=305 education and support (3-day-long group sessions on skill-based learning and education and 1-on-1 support for 12 months plus usual care).
N=303 usual care (self-help booklet on pain, opioids, and opioid tapering plus a relaxation CD).
Primary outcome
Discontinuation of opioids at 12 months
29%
7%
29.0 %
21.8 %
14.5 %
7.3 %
0.0 %
Education and
support
Usual
care
Significant
increase ▲
NNT = 4
Significant increase in discontinuation of opioids at 12 months (29% vs. 7%; OR 5.55, 95% CI 2.8 to 10.99).
Secondary outcomes
No significant difference in Patient-Reported Outcomes Measurement Information System Pain Interference Short Form 8a score at 12 months (-4.1 points vs. -3.17 points; MD -0.52, 95% CI -1.94 to 0.89).
Significant increase in opioid discontinuation at 4 months (26% vs. 3%; OR 11.61, 95% CI 5.06 to 26.63).
Significant increase in the percentage of patients achieving a ≥ 50% reduction in Morphine Equivalent Dose at 12 months (57% vs. 27%; OR 3.76, 95% CI 2.47 to 5.71).
Safety outcomes
No significant difference in serious adverse events.
Conclusion
In adult patients taking strong opioids to treat chronic nonmalignant pain, education and support were superior to usual care with respect to discontinuation of opioids at 12 months.
Reference
Harbinder K Sandhu, Katie Booth, Andrea D Furlan et al. Reducing Opioid Use for Chronic Pain With a Group-Based Intervention: A Randomized Clinical Trial. JAMA. 2023 May 23;329(20):1745-1756.
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