{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,30]],"date-time":"2026-10-30T02:00:23Z","timestamp":1793325623289,"version":"4.5.0"},"reference-count":31,"publisher":"American Medical Association (AMA)","issue":"20","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA"],"published-print":{"date-parts":[[2023,5,23]]},"abstract":"\n Importance<\/jats:title>\n Opioid use for chronic nonmalignant pain can be harmful.<\/jats:p>\n <\/jats:sec>\n \n Objective<\/jats:title>\n To test whether a multicomponent, group-based, self-management intervention reduced opioid use and improved pain-related disability compared with usual care.<\/jats:p>\n <\/jats:sec>\n \n Design, Setting, and Participants<\/jats:title>\n Multicentered, randomized clinical trial of 608 adults taking strong opioids (buprenorphine, dipipanone, morphine, diamorphine, fentanyl, hydromorphone, methadone, oxycodone, papaveretum, pentazocine, pethidine, tapentadol, and tramadol) to treat chronic nonmalignant pain. The study was conducted in 191 primary care centers in England between May 17, 2017, and January 30, 2019. Final follow-up occurred March 18, 2020.<\/jats:p>\n <\/jats:sec>\n \n Intervention<\/jats:title>\n Participants were randomized 1:1 to either usual care or 3-day\u2013long group sessions that emphasized skill-based learning and education, supplemented by 1-on-1 support delivered by a nurse and lay person for 12 months.<\/jats:p>\n <\/jats:sec>\n \n Main Outcomes and Measures<\/jats:title>\n The 2 primary outcomes were Patient-Reported Outcomes Measurement Information System Pain Interference Short Form 8a (PROMIS-PI-SF-8a) score (T-score range, 40.7-77; 77 indicates worst pain interference; minimal clinically important difference, 3.5) and the proportion of participants who discontinued opioids at 12 months, measured by self-report.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n Of 608 participants randomized (mean age, 61 years; 362 female [60%]; median daily morphine equivalent dose, 46 mg [IQR, 25 to 79]), 440 (72%) completed 12-month follow-up. There was no statistically significant difference in PROMIS-PI-SF-8a scores between the 2 groups at 12-month follow-up (\u22124.1 in the intervention and \u22123.17 in the usual care groups; between-group difference: mean difference, \u22120.52 [95% CI, \u22121.94 to 0.89];\n P<\/jats:italic>\n \u2009=\u2009.15). At 12 months, opioid discontinuation occurred in 65 of 225 participants (29%) in the intervention group and 15 of 208 participants (7%) in the usual care group (odds ratio, 5.55 [95% CI, 2.80 to 10.99]; absolute difference, 21.7% [95% CI, 14.8% to 28.6%];\n P<\/jats:italic>\n \u2009&amp;lt;\u2009.001). Serious adverse events occurred in 8% (25\/305) of the participants in the intervention group and 5% (16\/303) of the participants in the usual care group. The most common serious adverse events were gastrointestinal (2% in the intervention group and 0% in the usual care group) and locomotor\/musculoskeletal (2% in the intervention group and 1% in the usual care group). Four people (1%) in the intervention group received additional medical care for possible or probable symptoms of opioid withdrawal (shortness of breath, hot flushes, fever and pain, small intestinal bleed, and an overdose suicide attempt).\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions and Relevance<\/jats:title>\n 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.<\/jats:p>\n <\/jats:sec>\n \n Trial Registration<\/jats:title>\n \n isrctn.org Identifier:\n ISRCTN49470934<\/jats:ext-link>\n <\/jats:p>\n <\/jats:sec>","DOI":"10.1001\/jama.2023.6454","type":"journal-article","created":{"date-parts":[[2023,5,23]],"date-time":"2023-05-23T11:04:43Z","timestamp":1684839883000},"page":"1745","source":"Crossref","is-referenced-by-count":68,"title":["Reducing Opioid Use for Chronic Pain With a Group-Based Intervention"],"prefix":"10.1001","volume":"329","author":[{"given":"Harbinder K.","family":"Sandhu","sequence":"first","affiliation":[{"name":"Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Katie","family":"Booth","sequence":"additional","affiliation":[{"name":"Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrea D.","family":"Furlan","sequence":"additional","affiliation":[{"name":"Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada"},{"name":"Department of Medicine, University of Toronto, Toronto, Ontario, Canada"},{"name":"Institute for Work & Health, Toronto, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jane","family":"Shaw","sequence":"additional","affiliation":[{"name":"Department of Pain Medicine, James Cook University Hospital, Middlesbrough, United Kingdom"},{"name":"now with Boston Scientific, Hemel Hempstead, United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dawn","family":"Carnes","sequence":"additional","affiliation":[{"name":"Wolfson Institute of Population Health, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stephanie J. 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