Helping patients to manage chronic pain without strong opioids – a real possibility

The Ten Footsteps programme, developed by Live Well with Pain and experts from Wolfson Research Institute for Health and Wellbeing, provides effective ways for patients to self-manage their pain and equips clinicians to feel more confident in advising their patients how to manage their pain without medication.

The training scheme offered to clinicians was initially known as the Gabapentinoid and Opioid Tapering Toolkit, or GOTT. Developed and evaluated during the pandemic, the GOTT was first rolled out with clinicians from a GP practice in a highly deprived part of County Durham, UK.

GOTT was delivered by Live Well with Pain; it was tailored to individual clinicians’ learning needs and designed to raise confidence in how medical staff treat and advise patients experiencing chronic pain.

Now, in a new paper published in the British Journal of Pain, the effectiveness of this early iteration of Ten Footsteps has been assessed over a 12 month period.

Follow-up analysis was carried out 30 months later to evaluate the ongoing impact of the programme on opioid prescription rates.

Positive results

At the start of the study, the GP practice had one of the country’s highest rates of prescribing opioids, and clinicians were very low in confidence to deliver a pain management programme to their patients.

After clinicians adopted the GOTT, confidence was significantly raised and the practice brought high dose opioid prescriptions down to zero.

It also halved major opioid and gabapentinoid prescriptions – bringing the GP practice well below the national average.

You can download a PDF of the published study, here.

The project won the AHSN Bright ideas Health award in 2021.

Learnings from the project fed into what was later to become the Ten Footsteps training programme for health care practitioners, which Live Well with Pain has gone on to deliver to hundreds of clinicians up and down the country.

Potential ‘game-changer’

Professor Paul Chazot from Durham University’s Department of Biosciences and Wolfson Research Institute said: “Although this is a relatively small study, the programme we developed has been promoted by NICE and rolled out across the UK.

Dr Frances Cole, an Honorary Fellow of the Wolfson Research Institute and founder of Live Well with Pain, said: “The harmful side-effects of taking high doses of opioids are well-known and we’ve probably saved people’s lives by reducing their use to zero as a result of this training programme.”

The research is a small-scale proof of concept study, but the researchers say that depending on the results of formal pilot and clinical trials, it could be a ‘game-changer’ in the non-pharmacological management of chronic pain in the UK.

 

I am grateful to Durham University’s Alexa Fox, from whose news article this post has been adapted.