“I was prescribed opioids. They addled my brain, they made it difficult to think straight, my brain wasn’t functioning as it should. I would have nightmares a lot.”
Colin Tysall, an 81-year-old resident of Coventry, received a prescription for painkillers, which included opioids, to manage his long-standing chronic back pain. This condition was attributed to his three-decade career as an aircraft radiologist.
“I was an industrial radiologist and wore my back out x-raying aircraft parts and handling heavy castings for jet engines. The castings could weigh up to 200lbs and even though we would move some of the castings around in stillages, it was still a strain. We were having to move these castings around very carefully, with no lifting equipment.”
Colin began to suffer from sciatic pain radiating down both of his legs and was diagnosed with three herniated discs in his back. He vividly depicts the profound consequences of becoming dependent on painkillers:
“The treatment at the time was bedrest and painkillers. The tablets got stronger and stronger until eventually I was prescribed opioids,” said Colin.
“I spent so much time in bed that I lost the use of my legs and fell into a deep depression, so I was prescribed antidepressants too. I couldn’t look after my family, and at one point I tried to take my own life.
“I didn’t like being on tablets. They addled my brain, they made it difficult to think straight, my brain wasn’t functioning as it should. I would have nightmares a lot. As soon as I could come off them, I did.”
In the United Kingdom, the number of individuals relying on prescription opioids exceeds 1 million, with more than 50,000 people using them for six months or longer.
Despite the well-documented risks associated with long-term opioid consumption, there is currently a lack of alternative treatments available to safely assist individuals dealing with chronic, non-cancer pain who wish to discontinue opioid use.
However, a team of dedicated researchers and clinicians have developed an intervention program that has undergone successful trials. This program aims to guide individuals in tapering their opioid intake, provide education on managing pain through alternative techniques, and offer both one-to-one and group support.
A recent study, named I-WOTCH (Improving the Wellbeing of people with Opioid Treated Chronic Pain), has demonstrated the effectiveness of an intervention program in helping individuals with chronic pain reduce their reliance on opioids. The findings revealed that approximately 1 in 5 participants successfully discontinued their opioid use within one year, without the need for medication substitution or exacerbation of their pain.
Conducted between 2017 and 2020, the randomized controlled study involved over 600 individuals who had been regularly consuming potent opioids for a minimum of three months. Participants were recruited from general practitioner (GP) practices located in the North East of England and the Midlands.
The study compared two treatment approaches, with participants randomly assigned to one of two groups. The first group received their usual GP care along with a self-help booklet and relaxation CD, while the second group received the same resources in addition to an intervention program specifically developed by the research team.
The intervention program encompassed various sessions focusing on coping techniques, stress management, goal setting, mindfulness, posture and movement guidance, strategies to handle withdrawal symptoms, and pain management after opioid discontinuation.
Throughout the trial, participants completed questionnaires at regular intervals to assess their daily functioning and intake of painkillers.
After one year, it was found that 29 percent of individuals who underwent the intervention program were able to completely cease their opioid use, in contrast to just 7 percent of those who received standard GP care, the self-help booklet, and CD.
Importantly, there was no discernible difference between the two groups in terms of pain levels or the extent to which pain interfered with their daily lives. These findings suggest that the intervention program’s benefits extended beyond reducing opioid use, offering comparable pain relief and maintaining overall quality of life.
“Structured, group-based, psycho-educational self-management interventions help people to better manage their daily lives with a long-term condition, including persistent pain, but few of these have specifically targeted patients considering opioid withdrawal,” says lead author Harbinder Kaur Sandhu.
“Many people who have been taking prescription painkillers over a long period time suffer with harmful side effects but can feel reluctant to come off them because they think it could make their pain worse, or they do not know how to approach this with their clinician.
“Our trial has found a treatment that could help people to come off opioids, in a way that is safe, supportive and gradual. It’s a supported decision between the patient and the clinician, and not forced tapering. The programme helps people to learn alternative ways to manage their pain and help overcome challenges of withdrawal and has the potential to give people an overall better quality of life.”
Colin, who had been seeking medical care for his back and mental health issues for a decade, decided to explore alternative treatments in his quest for pain relief.
“I found that the best treatment for me was exercise. I got involved with mental health self-health groups, and I became friends with people experiencing similar problems. We would walk and talk together, which was the opposite of the guidelines at the time, but I found it helped keep my mind off the pain, and it made it easier to cope.”
Colin dedicated a couple of years to gradually reducing his medication dosage until he was able to completely discontinue the tablets. As a result, he has recently noticed a significant reduction in his pain.
Motivated by his own experiences, Colin pursued a career as an associate mental health manager. He currently works at Coventry and Warwick universities, where he actively contributes to the training of psychiatric and nursing students.
Colin’s involvement extended further when he joined the University of Warwick’s Clinical Trials Unit. As a trained I-WOTCH lay person, he plays a crucial role in supporting patients during the group support sessions of the I-WOTCH clinical trial.
“Our trial is the culmination of six years of work during which we learned that the harms from long term opioids extend beyond the individual into their social circle. Patients taking opioids lose interest in social interaction with family and friends and gradually withdraw from society into an opioid-induced mental fog,” adds co-lead author Professor Sam Eldabe.
“Despite appreciating the social impact of the drugs, most patients utterly dread a worsening of their pain should they attempt to reduce their opioids.
“Our study shows clearly that opioids can be gradually reduced and stopped within no actual worsening of the pain. This confirms our suspicions that opioids have very little long-term impact on persistent pain.”
Source: 10.1001/jama.2023.6454
Image Credit: Getty
