{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,15]],"date-time":"2026-05-15T13:09:26Z","timestamp":1778850566849,"version":"3.51.4"},"reference-count":90,"publisher":"National Institute for Health and Care Research","license":[{"start":{"date-parts":[[2026,5,1]],"date-time":"2026-05-01T00:00:00Z","timestamp":1777593600000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100000664","name":"Health Technology Assessment programme","doi-asserted-by":"publisher","award":["14\/224\/04"],"award-info":[{"award-number":["14\/224\/04"]}],"id":[{"id":"10.13039\/501100000664","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["journalslibrary.nihr.ac.uk"],"crossmark-restriction":false},"short-container-title":["Health Technol Assess"],"abstract":"<jats:sec id=\"abs1-1\">\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>The long-term use of strong opioids for chronic non-cancer pain puts people at risk of serious harm.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"abs1-2\">\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>To test the effectiveness and cost-effectiveness of a multicomponent intervention targeting opioid use for the treatment of chronic pain.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"abs1-3\">\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>A multicentred randomised controlled trial with embedded process evaluation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"abs1-4\">\n                    <jats:title>Setting<\/jats:title>\n                    <jats:p>Primary care.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"abs1-5\">\n                    <jats:title>Participants<\/jats:title>\n                    <jats:p>Adults using strong opioids for non-malignant chronic.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"abs1-6\">\n                    <jats:title>Interventions<\/jats:title>\n                    <jats:p>Participants were randomised 1 : 1 (using a minimisation programme stratified by geographical locality, baseline pain intensity score and baseline morphine equivalent dose) to either usual care (an educational booklet and relaxation compact disc) or usual care plus the I-WOTCH intervention; 3 day-long group sessions delivered by a nurse and lay facilitator, plus a one-to-one session and ongoing telephone contact from the nurse to support opioid tapering.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"abs1-7\">\n                    <jats:title>Main outcome measures<\/jats:title>\n                    <jats:p>The two primary outcomes were Patient-Reported Outcomes Measurement Information System Pain Interference Short Form (8A), and proportion using no opioids, at 12 months.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"abs1-8\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>We randomised 608 people. At 12 months, there was no between-group difference in Patient-Reported Outcomes Measurement Information System Pain Interference Short Form (8A) scores; mean difference, \u22120.52 (95% confidence interval \u22121.94 to 0.89). At 12 months, 65\/225 (29%) of people in the intervention group and 15\/208 (7%) of people in usual-care group reported using no opioids [odds ratio 5.55 (95% confidence interval 2.80 to 10.99)], absolute difference, 21.7% (95% confidence interval 14.8 to 28.6). Over a lifetime horizon, I-WOTCH is on average associated with an incremental cost of \u00a39277 per person, and provides an additional 0.314 quality-adjusted life-years. The deterministic incremental cost per quality-adjusted life-year gained was \u00a329,543. The I-WOTCH intervention may be cost-effective compared to best usual care. The process evaluation suggested group support and shared experience were important to those trying to taper.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"abs1-9\">\n                    <jats:title>Limitations<\/jats:title>\n                    <jats:p>The opioid use analysis is based solely on participant self-report. The findings only apply to people willing to consider opioid reduction and may not apply to a more complex secondary care population. The results may not be applicable to people using very high opioid doses.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"abs1-10\">\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>The I-WOTCH intervention helps substantially more people stop opioids than best usual care without adversely affecting pain interference.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"abs1-11\">\n                    <jats:title>Future work<\/jats:title>\n                    <jats:p>The I-WOTCH intervention should be tested in different healthcare settings and other populations.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"abs1-12\">\n                    <jats:title>Trial registration<\/jats:title>\n                    <jats:p>This trial is registered as Current Controlled Trials ISRCTN49470934.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"abs1-13\">\n                    <jats:title>Funding<\/jats:title>\n                    <jats:p>\n                      This award was funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme (NIHR award ref: 14\/224\/04) and is published in full in\n                      <jats:italic>Health Technology Assessment<\/jats:italic>\n                      ; Vol. 30, No. 35. See the NIHR Funding and Awards website for further award information.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.3310\/gjhs2715","type":"journal-article","created":{"date-parts":[[2025,7,15]],"date-time":"2025-07-15T07:54:13Z","timestamp":1752566053000},"page":"1-174","update-policy":"https:\/\/doi.org\/10.3310\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Effects and costs of a group-based educational intervention to reduce opioid use in people with chronic pain: I-WOTCH RCT"],"prefix":"10.3310","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1522-8078","authenticated-orcid":true,"given":"Harbinder K","family":"Sandhu","sequence":"first","affiliation":[{"name":"Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8530-2566","authenticated-orcid":true,"given":"Katie","family":"Booth","sequence":"additional","affiliation":[{"name":"Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8574-695X","authenticated-orcid":true,"given":"Sheeja","family":"Manchira Krishnan","sequence":"additional","affiliation":[{"name":"Department of Health Sciences, University of York, York, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0901-1975","authenticated-orcid":true,"given":"Charles","family":"Abraham","sequence":"additional","affiliation":[{"name":"School of Psychology, Deakin University, Geelong, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8026-1176","authenticated-orcid":true,"given":"Sharisse","family":"Alleyne","sequence":"additional","affiliation":[{"name":"Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5149-3595","authenticated-orcid":true,"given":"Shyam","family":"Balasubramanian","sequence":"additional","affiliation":[{"name":"Department of Anaesthesia and Pain Medicine, University Hospital Coventry and Warwickshire NHS Trust, Coventry, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-6072-2581","authenticated-orcid":true,"given":"Lauren","family":"Betteley","sequence":"additional","affiliation":[{"name":"Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2494-5685","authenticated-orcid":true,"given":"Tom","family":"Bromilow","sequence":"additional","affiliation":[{"name":"York Health Economics Consortium, University of York, York, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3152-3133","authenticated-orcid":true,"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, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6138-8510","authenticated-orcid":true,"given":"Andrea D","family":"Furlan","sequence":"additional","affiliation":[{"name":"Toronto Rehabilitation Institute, University Health Network, Toronto, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0365-2605","authenticated-orcid":true,"given":"Vijay S","family":"Gc","sequence":"additional","affiliation":[{"name":"Centre for Health Economics, University of York, York, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5405-187X","authenticated-orcid":true,"given":"Kirstie L","family":"Haywood","sequence":"additional","affiliation":[{"name":"Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-4691-5416","authenticated-orcid":true,"given":"Maddy","family":"Hill","sequence":"additional","affiliation":[{"name":"Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3426-0930","authenticated-orcid":true,"given":"Cynthia P","family":"Iglesias-Urrutia","sequence":"additional","affiliation":[{"name":"Department of Health Sciences, University of York, York, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1737-2866","authenticated-orcid":true,"given":"Ranjit","family":"Lall","sequence":"additional","affiliation":[{"name":"Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8342-8421","authenticated-orcid":true,"given":"Andrea","family":"Manca","sequence":"additional","affiliation":[{"name":"Centre for Health Economics, University of York, York, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0875-9260","authenticated-orcid":true,"given":"Dipesh","family":"Mistry","sequence":"additional","affiliation":[{"name":"Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1866-9752","authenticated-orcid":true,"given":"Joe WE","family":"Moss","sequence":"additional","affiliation":[{"name":"York Health Economics Consortium, University of York, York, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8035-0411","authenticated-orcid":true,"given":"Sian","family":"Newton","sequence":"additional","affiliation":[{"name":"Wolfson Institute of Population Health, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3372-1395","authenticated-orcid":true,"given":"Vivien P","family":"Nichols","sequence":"additional","affiliation":[{"name":"Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-4005-1267","authenticated-orcid":true,"given":"Jennifer","family":"Noyes","sequence":"additional","affiliation":[{"name":"Department of Pain Medicine, James Cook University Hospital, Middlesbrough, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4832-9609","authenticated-orcid":true,"given":"Emma","family":"Padfield","sequence":"additional","affiliation":[{"name":"Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2346-4484","authenticated-orcid":true,"given":"Anisur","family":"Rahman","sequence":"additional","affiliation":[{"name":"Centre for Rheumatology Research, University College London, London, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7921-552X","authenticated-orcid":true,"given":"Kate","family":"Seers","sequence":"additional","affiliation":[{"name":"Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jane","family":"Shaw","sequence":"additional","affiliation":[{"name":"Department of Pain Medicine, James Cook University Hospital, Middlesbrough, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7836-9965","authenticated-orcid":true,"given":"Nicole KY","family":"Tang","sequence":"additional","affiliation":[{"name":"Department of Psychology, University of Warwick, Coventry, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7454-6354","authenticated-orcid":true,"given":"Stephanie JC","family":"Taylor","sequence":"additional","affiliation":[{"name":"Wolfson Institute of Population Health, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5109-3989","authenticated-orcid":true,"given":"Colin","family":"Tysall","sequence":"additional","affiliation":[{"name":"University\/User Teaching and Research Action Partnership, University of Warwick, Coventry, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0309-1708","authenticated-orcid":true,"given":"Martin","family":"Underwood","sequence":"additional","affiliation":[{"name":"Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9250-1886","authenticated-orcid":true,"given":"Sam","family":"Eldabe","sequence":"additional","affiliation":[{"name":"Department of Pain Medicine, James Cook University Hospital, Middlesbrough, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"6221","published-online":{"date-parts":[[2026,5]]},"reference":[{"key":"key2026051517430300_ref1-bib1","doi-asserted-by":"crossref","first-page":"1745","DOI":"10.1001\/jama.2023.6454","article-title":"Reducing opioid use for chronic pain with a group-based intervention: a randomized clinical trial","volume":"329","author":"Sandhu","year":"2023","journal-title":"JAMA"},{"key":"key2026051517430300_ref2-bib2","doi-asserted-by":"crossref","first-page":"e028937","DOI":"10.1136\/bmjopen-2019-028937","article-title":"Testing a support programme for opioid reduction for people with chronic non-malignant pain: the I-WOTCH randomised controlled trial protocol","volume":"9","author":"Sandhu","year":"2019","journal-title":"BMJ Open"},{"key":"key2026051517430300_ref3-bib3","doi-asserted-by":"crossref","first-page":"e053725","DOI":"10.1136\/bmjopen-2021-053725","article-title":"Development and testing of an opioid tapering self-management intervention for chronic pain: I-WOTCH","volume":"12","author":"Sandhu","year":"2022","journal-title":"BMJ Open"},{"key":"key2026051517430300_ref4-bib4","doi-asserted-by":"crossref","first-page":"e028998","DOI":"10.1136\/bmjopen-2019-028998","article-title":"Process evaluation protocol for the I-WOTCH study: an opioid tapering support programme for people with chronic non-malignant pain","volume":"9","author":"Nichols","year":"2019","journal-title":"BMJ Open"},{"key":"key2026051517430300_ref5-bib5","doi-asserted-by":"crossref","first-page":"e074603","DOI":"10.1136\/bmjopen-2023-074603","article-title":"\u2018It was a joint plan we worked out together\u2019. How the I-WOTCH programme enabled people with chronic non-malignant pain to taper their opioids: a process evaluation","volume":"13","author":"Nichols","year":"2023","journal-title":"BMJ Open"},{"key":"key2026051517430300_ref6-bib6","doi-asserted-by":"crossref","first-page":"1976","DOI":"10.1097\/j.pain.0000000000001939","article-title":"The revised International Association for the Study of Pain definition of pain: concepts, challenges, and compromises","volume":"161","author":"Raja","year":"2020","journal-title":"Pain"},{"key":"key2026051517430300_ref7-bib7","doi-asserted-by":"crossref","first-page":"1204","DOI":"10.1016\/S0140-6736(20)30925-9","article-title":"Global burden of 369 diseases and injuries in 204 countries and territories, 1990\u20132019: a systematic analysis for the Global Burden of Disease Study 2019","volume":"396","author":"Vos","year":"2020","journal-title":"The Lancet"},{"key":"key2026051517430300_ref8-bib8","doi-asserted-by":"crossref","first-page":"e010364","DOI":"10.1136\/bmjopen-2015-010364","article-title":"Prevalence of chronic pain in the UK: a systematic review and meta-analysis of population studies","volume":"6","author":"Fayaz","year":"2016","journal-title":"BMJ Open"},{"key":"key2026051517430300_ref9-bib9","doi-asserted-by":"crossref","first-page":"121","DOI":"10.1186\/s12875-015-0335-5","article-title":"Understanding long-term opioid prescribing for non-cancer pain in primary care: a qualitative study","volume":"16","author":"McCrorie","year":"2015","journal-title":"BMC Fam Pract"},{"key":"key2026051517430300_ref10-bib10","doi-asserted-by":"crossref","first-page":"175","DOI":"10.1093\/ageing\/afz175","article-title":"A systematic review of the evidence for the efficacy of opioids for chronic non-cancer pain in community-dwelling older adults","volume":"49","author":"O\u2019Brien","year":"2020","journal-title":"Age Ageing"},{"key":"key2026051517430300_ref11-bib11","volume-title":"Opioid Prescribing Comparators Dashboard","author":"NHS Business Services Authority"},{"key":"key2026051517430300_ref12-bib12","doi-asserted-by":"crossref","first-page":"R1046","DOI":"10.1186\/ar1782","article-title":"Prevalence of opioid adverse events in chronic non-malignant pain: systematic review of randomised trials of oral opioids","volume":"7","author":"Moore","year":"2005","journal-title":"Arthritis Res Ther"},{"key":"key2026051517430300_ref13-bib13","doi-asserted-by":"crossref","first-page":"1343","DOI":"10.1002\/j.1532-2149.2014.496.x","article-title":"Changes in trends and pattern of strong opioid prescribing in primary care","volume":"18","author":"Zin","year":"2014","journal-title":"Eur J Pain"},{"key":"key2026051517430300_ref14-bib14","doi-asserted-by":"crossref","first-page":"e1003270","DOI":"10.1371\/journal.pmed.1003270","article-title":"Time trends and prescribing patterns of opioid drugs in UK primary care patients with non-cancer pain: a retrospective cohort study","volume":"17","author":"Jani","year":"2020","journal-title":"PLOS Med"},{"key":"key2026051517430300_ref16-bib16","doi-asserted-by":"crossref","first-page":"128","DOI":"10.1136\/jech-2020-214676","article-title":"Association of socioeconomic deprivation with opioid prescribing in primary care in England: a spatial analysis","volume":"75","author":"Nowakowska","year":"2021","journal-title":"J Epidemiol Community Health"},{"key":"key2026051517430300_ref17-bib17","article-title":"Interventions for the reduction of prescribed opioid use in chronic non-cancer pain","volume":"11","author":"Eccleston","year":"2017","journal-title":"Cochrane Database Syst Rev"},{"key":"key2026051517430300_ref18-bib18","volume-title":"National Drug Treatment Monitoring System (NDTMS)","author":"Office for Health Improvement and Disparities"},{"key":"key2026051517430300_ref19-bib19","doi-asserted-by":"crossref","first-page":"e1002040","DOI":"10.1371\/journal.pmed.1002040","article-title":"Novel three-day, community-based, nonpharmacological group intervention for chronic musculoskeletal pain (COPERS): a randomised clinical trial","volume":"13","author":"Taylor","year":"2016","journal-title":"PLOS Med"},{"key":"key2026051517430300_ref20-bib20","doi-asserted-by":"crossref","first-page":"1563","DOI":"10.1007\/s40265-020-01368-y","article-title":"Deprescribing opioids in chronic non-cancer pain: systematic review of randomised trials","volume":"80","author":"Mathieson","year":"2020","journal-title":"Drugs"},{"key":"key2026051517430300_ref21-bib21","doi-asserted-by":"crossref","first-page":"e066375","DOI":"10.1136\/bmj-2021-066375","article-title":"Efficacy of interventions to reduce long term opioid treatment for chronic non-cancer pain: systematic review and meta-analysis","volume":"377","author":"Avery","year":"2022","journal-title":"BMJ"},{"key":"key2026051517430300_ref22-bib22","doi-asserted-by":"crossref","first-page":"e293","DOI":"10.3399\/BJGP.2021.0537","article-title":"Opioid reduction for patients with chronic pain in primary care: systematic review","volume":"72","author":"de Kleijn","year":"2022","journal-title":"Br J Gen Pract"},{"key":"key2026051517430300_ref24-bib24","doi-asserted-by":"crossref","first-page":"280","DOI":"10.1016\/j.jpainsymman.2007.10.003","article-title":"Epidemiology of regular prescribed opioid use: results from a national, population-based survey","volume":"36","author":"Hudson","year":"2008","journal-title":"J Pain Symptom Manage"},{"key":"key2026051517430300_ref25-bib25","doi-asserted-by":"crossref","first-page":"507","DOI":"10.1016\/j.pain.2008.01.027","article-title":"Prevalence and characteristics of opioid use in the US adult population","volume":"138","author":"Kelly","year":"2008","journal-title":"Pain"},{"key":"key2026051517430300_ref26-bib26","doi-asserted-by":"crossref","first-page":"1377","DOI":"10.1136\/bmj.38282.669225.AE","article-title":"United Kingdom back pain exercise and manipulation (UK BEAM) randomised trial: effectiveness of physical treatments for back pain in primary care","volume":"329","author":"UK BEAM Trial Team","year":"2004","journal-title":"BMJ"},{"key":"key2026051517430300_ref27-bib27","doi-asserted-by":"crossref","first-page":"916","DOI":"10.1016\/S0140-6736(09)62164-4","article-title":"Group cognitive behavioural treatment for low-back pain in primary care: a randomised controlled trial and cost-effectiveness analysis","volume":"375","author":"Lamb","year":"2010","journal-title":"Lancet"},{"key":"key2026051517430300_ref28-bib28","doi-asserted-by":"crossref","first-page":"1","DOI":"10.3310\/pgfar04140","article-title":"Improving the self-management of chronic pain: COping with persistent Pain, Effectiveness Research in Self-management (COPERS)","volume":"4","author":"Taylor","year":"2016","journal-title":"Programme Grants Appl Res"},{"key":"key2026051517430300_ref29-bib29","doi-asserted-by":"crossref","first-page":"a1655","DOI":"10.1136\/bmj.a1655","article-title":"Developing and evaluating complex interventions: the new Medical Research Council guidance","volume":"337","author":"Craig","year":"2008","journal-title":"BMJ"},{"key":"key2026051517430300_ref30-bib30","doi-asserted-by":"crossref","first-page":"191","DOI":"10.1037\/0033-295X.84.2.191","article-title":"Self-efficacy: toward a unifying theory of behavioral change","volume":"84","author":"Bandura","year":"1977","journal-title":"Psychol Rev"},{"key":"key2026051517430300_ref31-bib31","volume-title":"Belief, Attitude, Intention and Behaviour: An Introduction to Theory and Research","author":"Fishbein","year":"1975"},{"key":"key2026051517430300_ref32-bib32","volume-title":"Understanding Attitudes and Predicting Social Behavior","author":"Ajzen","year":"1980"},{"key":"key2026051517430300_ref33-bib33","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1080\/16506070310001794","article-title":"Developing a treatment manual for attention management in chronic pain","volume":"33","author":"Morley","year":"2004","journal-title":"Cogn Behav Ther"},{"key":"key2026051517430300_ref34-bib34","doi-asserted-by":"crossref","first-page":"581","DOI":"10.1037\/0033-2909.133.4.581","article-title":"The biopsychosocial approach to chronic pain: scientific advances and future directions","volume":"133","author":"Gatchel","year":"2007","journal-title":"Psychol Bull"},{"key":"key2026051517430300_ref35-bib35","volume-title":"Action Control: From Cognition to Behavior","author":"Kuhl","year":"2012"},{"key":"key2026051517430300_ref36-bib36","article-title":"Psychological therapies for the management of chronic pain (excluding headache) in adults","volume":"8","author":"Williams","year":"2020","journal-title":"Cochrane Database Syst Rev"},{"key":"key2026051517430300_ref37-bib37","doi-asserted-by":"crossref","first-page":"42","DOI":"10.1186\/1748-5908-6-42","article-title":"The behaviour change wheel: a new method for characterising and designing behaviour change interventions","volume":"6","author":"Michie","year":"2011","journal-title":"Implement Sci"},{"key":"key2026051517430300_ref38-bib38","volume-title":"Motivational Interviewing: Preparing People to Change Addictive Behavior","author":"Miller","year":"1991"},{"key":"key2026051517430300_ref39-bib39","doi-asserted-by":"crossref","first-page":"100596","DOI":"10.1016\/j.eclinm.2020.100596","article-title":"Efficacy of motivational-interviewing and guided opioid tapering support for patients undergoing orthopedic surgery (MI-Opioid Taper): a prospective, assessor-blind, randomized controlled pilot trial","volume":"28","author":"Hah","year":"2020","journal-title":"EClinicalMedicine"},{"key":"key2026051517430300_ref40-bib40","doi-asserted-by":"crossref","first-page":"828","DOI":"10.1016\/j.mayocp.2015.04.003","article-title":"Tapering long-term opioid therapy in chronic noncancer pain: evidence and recommendations for everyday practice","volume":"90","author":"Berna","year":"2015","journal-title":"Mayo Clin Proc"},{"key":"key2026051517430300_ref41-bib41","volume-title":"Dose Equivalents and Changing Opioids","author":"Faculty of Pain Medicine of the Royal College of Anaesthetists"},{"key":"key2026051517430300_ref42-bib42","volume-title":"My Opioid Manager","author":"Furlan","year":"2015"},{"key":"key2026051517430300_ref43-bib43","doi-asserted-by":"crossref","first-page":"173","DOI":"10.1016\/j.pain.2010.04.025","article-title":"Development of a PROMIS item bank to measure pain interference","volume":"150","author":"Amtmann","year":"2010","journal-title":"Pain"},{"key":"key2026051517430300_ref44-bib44","doi-asserted-by":"crossref","first-page":"133","DOI":"10.1016\/0304-3959(92)90154-4","article-title":"Grading the severity of chronic pain","volume":"50","author":"Von Korff","year":"1992","journal-title":"Pain"},{"key":"key2026051517430300_ref45-bib45","doi-asserted-by":"crossref","first-page":"1625","DOI":"10.1002\/acr.22025","article-title":"Validity and reliability of patient-reported outcomes measurement information system instruments in osteoarthritis","volume":"65","author":"Broderick","year":"2013","journal-title":"Arthritis Care Res"},{"key":"key2026051517430300_ref46-bib46","doi-asserted-by":"crossref","first-page":"487","DOI":"10.1016\/0306-4603(90)90036-W","article-title":"The development of a Short Opiate Withdrawal Scale (SOWS)","volume":"15","author":"Gossop","year":"1990","journal-title":"Addict Behav"},{"key":"key2026051517430300_ref47-bib47","doi-asserted-by":"crossref","first-page":"1171","DOI":"10.1016\/S0895-4356(98)00109-7","article-title":"Cross-validation of item selection and scoring for the SF-12 Health Survey in nine countries: results from the IQOLA Project. International Quality of Life Assessment","volume":"51","author":"Gandek","year":"1998","journal-title":"J Clin Epidemiol"},{"key":"key2026051517430300_ref48-bib48","doi-asserted-by":"crossref","first-page":"1727","DOI":"10.1007\/s11136-011-9903-x","article-title":"Development and preliminary testing of the new five-level version of EQ-5D (EQ-5D-5L)","volume":"20","author":"Herdman","year":"2011","journal-title":"Qual Life Res"},{"key":"key2026051517430300_ref49-bib49","doi-asserted-by":"crossref","first-page":"193","DOI":"10.1016\/0165-1781(89)90047-4","article-title":"The Pittsburgh Sleep Quality Index: a new instrument for psychiatric practice and research","volume":"28","author":"Buysse","year":"1989","journal-title":"Psychiatry Res"},{"key":"key2026051517430300_ref50-bib50","doi-asserted-by":"crossref","first-page":"361","DOI":"10.1111\/j.1600-0447.1983.tb09716.x","article-title":"The hospital anxiety and depression scale","volume":"67","author":"Zigmond","year":"1983","journal-title":"Acta Psychiatr Scand"},{"key":"key2026051517430300_ref51-bib51","doi-asserted-by":"crossref","first-page":"153","DOI":"10.1016\/j.ejpain.2005.12.008","article-title":"The pain self-efficacy questionnaire: taking pain into account","volume":"11","author":"Nicholas","year":"2007","journal-title":"Eur J Pain"},{"key":"key2026051517430300_ref52-bib52","doi-asserted-by":"crossref","first-page":"571","DOI":"10.1111\/j.1399-6576.2009.02164.x","article-title":"Patients with problematic opioid use can be weaned from codeine without pain escalation","volume":"54","author":"Nilsen","year":"2010","journal-title":"Acta Anaesthesiol Scand"},{"key":"key2026051517430300_ref53-bib53","doi-asserted-by":"crossref","first-page":"279","DOI":"10.1016\/0304-3959(94)90166-X","article-title":"Opiate reduction in chronic pain patients: a comparison of patient-controlled reduction and staff controlled cocktail methods","volume":"56","author":"Ralphs","year":"1994","journal-title":"Pain"},{"key":"key2026051517430300_ref54-bib54","doi-asserted-by":"crossref","first-page":"337","DOI":"10.1016\/j.pain.2003.08.001","article-title":"Core outcome domains for chronic pain clinical trials: IMMPACT recommendations","volume":"106","author":"Turk","year":"2003","journal-title":"Pain"},{"key":"key2026051517430300_ref55-bib55","doi-asserted-by":"crossref","first-page":"149","DOI":"10.1037\/a0023464","article-title":"Evaluating models for partially clustered designs","volume":"16","author":"Baldwin","year":"2011","journal-title":"Psychol Methods"},{"key":"key2026051517430300_ref56-bib56","doi-asserted-by":"crossref","first-page":"105","DOI":"10.1186\/s12874-018-0559-x","article-title":"Appropriate statistical methods for analysing partially nested randomised controlled trials with continuous outcomes: a simulation study","volume":"18","author":"Candlish","year":"2018","journal-title":"BMC Med Res Methodol"},{"key":"key2026051517430300_ref57-bib57","doi-asserted-by":"crossref","first-page":"378","DOI":"10.32614\/RJ-2017-066","article-title":"glmmTMB balances speed and flexibility among packages for zero-inflated generalized linear mixed modeling","volume":"9","author":"Brooks","year":"2017","journal-title":"The R Journal"},{"key":"key2026051517430300_ref58-bib58","doi-asserted-by":"crossref","first-page":"1080","DOI":"10.1136\/bmj.332.7549.1080","article-title":"The cost of dichotomising continuous variables","volume":"332","author":"Altman","year":"2006","journal-title":"BMJ"},{"key":"key2026051517430300_ref59-bib59","doi-asserted-by":"crossref","first-page":"708","DOI":"10.1016\/j.jval.2012.02.008","article-title":"Interim scoring for the EQ-5D-5L: mapping the EQ-5D-5L to EQ-5D-3L value sets","volume":"15","author":"van Hout","year":"2012","journal-title":"Value Health"},{"key":"key2026051517430300_ref60-bib60","doi-asserted-by":"crossref","first-page":"e037243","DOI":"10.1136\/bmjopen-2020-037243","article-title":"Protocol for an economic analysis of the randomised controlled trial of Improving the Well-being of people with Opioid Treated CHronic pain: I-WOTCH Study","volume":"10","author":"Manchira Krishnan","year":"2020","journal-title":"BMJ Open"},{"key":"key2026051517430300_ref61-bib61","doi-asserted-by":"crossref","first-page":"1157","DOI":"10.1007\/s40273-014-0193-3","article-title":"A guide to handling missing data in cost-effectiveness analysis conducted within randomised controlled trials","volume":"32","author":"Faria","year":"2014","journal-title":"PharmacoEconomics"},{"key":"key2026051517430300_ref62-bib62","volume-title":"Imputation by Predictive Mean Matching: Promise & Peril","author":"Allison","year":"2015"},{"key":"key2026051517430300_ref63-bib63","doi-asserted-by":"crossref","first-page":"425","DOI":"10.1016\/0167-9473(95)00057-7","article-title":"Partially parametric techniques for multiple imputation","volume":"22","author":"Schenker","year":"1996","journal-title":"Comput Stat Data Anal"},{"key":"key2026051517430300_ref64-bib64","first-page":"1","article-title":"mice: multivariate imputation by chained equations in R","volume":"45","author":"van Buuren","year":"2011","journal-title":"J Stat Softw"},{"key":"key2026051517430300_ref65-bib65","volume-title":"British National Formulary (BNF)","author":"National Institute for Health and Clinical Excellence","year":"2023"},{"key":"key2026051517430300_ref66-bib66","volume-title":"Reference Costs 2018\/19: Highlights, Analysis and Introduction to the Data","author":"NHS Improvement","year":"2019"},{"key":"key2026051517430300_ref67-bib67","volume-title":"Unit Costs of Health and Social Care","author":"Curtis","year":"2019"},{"key":"key2026051517430300_ref68-bib68","volume-title":"Unit Costs of Health and Social Care","author":"Curtis","year":"2013"},{"key":"key2026051517430300_ref69-bib69","volume-title":"Unit Costs of Health and Social Care","author":"Curtis","year":"2018"},{"key":"key2026051517430300_ref70-bib70","volume-title":"Inflation and Price Indices","author":"Office for National Statistics","year":"2019"},{"key":"key2026051517430300_ref71-bib71","volume-title":"Guide to the Methods of Technology Appraisal","author":"National Institute for Health and Clinical Excellence","year":"2013"},{"key":"key2026051517430300_ref72-bib72","volume-title":"A Brief Guide to the PROMIS\u00a9 Pain Interference Instruments","author":"HealthMeasures","year":"2023"},{"key":"key2026051517430300_ref73-bib73","doi-asserted-by":"crossref","first-page":"109","DOI":"10.1016\/j.addbeh.2016.03.028","article-title":"Psychometric evaluation of the 10-item Short Opiate Withdrawal Scale-Gossop (SOWS-Gossop) in patients undergoing opioid detoxification","volume":"60","author":"Vernon","year":"2016","journal-title":"Addict Behav"},{"key":"key2026051517430300_ref74-bib74","volume-title":"Position Statement on Use of the EQ-5D-5L Value Set for England","author":"National Institute for Health and Clinical Excellence","year":"2019"},{"key":"key2026051517430300_ref75-bib75","doi-asserted-by":"crossref","first-page":"7","DOI":"10.1002\/hec.3564","article-title":"Valuing health-related quality of life: an EQ-5D-5L value set for England","volume":"27","author":"Devlin","year":"2018","journal-title":"Health Econ"},{"key":"key2026051517430300_ref76-bib76","volume-title":"Deaths Registered in England and Wales 2019","author":"Office for National Statistics"},{"key":"key2026051517430300_ref77-bib77","doi-asserted-by":"crossref","first-page":"995","DOI":"10.1016\/j.jval.2019.04.1926","article-title":"Estimating the marginal productivity of the English National Health Service from 2003 to 2012","volume":"22","author":"Lomas","year":"2019","journal-title":"Value Health"},{"key":"key2026051517430300_ref78-bib78","doi-asserted-by":"crossref","first-page":"405","DOI":"10.1002\/hec.903","article-title":"Cost-effectiveness acceptability curves \u2013 facts, fallacies and frequently asked questions","volume":"13","author":"Fenwick","year":"2004","journal-title":"Health Econ"},{"key":"key2026051517430300_ref79-bib79","volume-title":"voi: Expected Value of Information","author":"Jackson","year":"2024"},{"key":"key2026051517430300_ref80-bib80","doi-asserted-by":"crossref","first-page":"292","DOI":"10.1093\/aje\/kws412","article-title":"The table 2 fallacy: presenting and interpreting confounder and modifier coefficients","volume":"177","author":"Westreich","year":"2013","journal-title":"Am J Epidemiol"},{"key":"key2026051517430300_ref81-bib81","doi-asserted-by":"crossref","first-page":"963","DOI":"10.1186\/s12889-015-2300-6","article-title":"A checklist to improve reporting of group-based behaviour-change interventions","volume":"15","author":"Borek","year":"2015","journal-title":"BMC Public Health"},{"key":"key2026051517430300_ref82-bib82","volume-title":"Social Psychological Foundations of Health and Illness","author":"Fisher","year":"2003"},{"key":"key2026051517430300_ref83-bib83","doi-asserted-by":"crossref","first-page":"77","DOI":"10.1191\/1478088706qp063oa","article-title":"Using thematic analysis in psychology","volume":"3","author":"Braun","year":"2006","journal-title":"Qual Res Psychol"},{"key":"key2026051517430300_ref84-bib84","doi-asserted-by":"crossref","first-page":"c4587","DOI":"10.1136\/bmj.c4587","article-title":"Three techniques for integrating data in mixed methods studies","volume":"341","author":"O\u2019Cathain","year":"2010","journal-title":"BMJ"},{"key":"key2026051517430300_ref85-bib85","doi-asserted-by":"crossref","first-page":"388","DOI":"10.1001\/jama.2021.11118","article-title":"Opioid tapering practices-time for reconsideration?","volume":"326","author":"Larochelle","year":"2021","journal-title":"JAMA"},{"key":"key2026051517430300_ref86-bib86","doi-asserted-by":"crossref","first-page":"509","DOI":"10.1097\/j.pain.0000000000001763","article-title":"Reducing the use of opioids by patients with chronic pain: an effectiveness study with long-term follow-up","volume":"161","author":"Nicholas","year":"2020","journal-title":"Pain"},{"key":"key2026051517430300_ref87-bib87","doi-asserted-by":"crossref","first-page":"133","DOI":"10.1136\/bmjqs-2020-010881","article-title":"Challenges of opioid deprescribing and factors to be considered in the development of opioid deprescribing guidelines: a qualitative analysis","volume":"30","author":"Langford","year":"2021","journal-title":"BMJ Qual Saf"},{"key":"key2026051517430300_ref88-bib88","volume-title":"Dependence and Withdrawal Associated with Some Prescribed Medicines: An Evidence Review","author":"Taylor","year":"2019"},{"key":"key2026051517430300_ref89-bib89","volume-title":"Deaths Related to Drug Poisoning in England and Wales: 2018 Registrations","author":"John","year":"2019"},{"key":"key2026051517430300_ref90-bib90","doi-asserted-by":"crossref","first-page":"407","DOI":"10.1001\/jamainternmed.2022.0033","article-title":"Mindfulness-oriented recovery enhancement vs supportive group therapy for co-occurring opioid misuse and chronic pain in primary care: a randomized clinical trial","volume":"182","author":"Garland","year":"2022","journal-title":"JAMA Int Med"},{"key":"key2026051517430300_ref91-bib91","doi-asserted-by":"crossref","first-page":"159","DOI":"10.1111\/j.1467-9566.2004.00385.x","article-title":"Investigation of the ways in which patients\u2019 reports of their satisfaction with healthcare are constructed","volume":"26","author":"Edwards","year":"2004","journal-title":"Sociol Health Illn"},{"key":"key2026051517430300_ref92-bib92","doi-asserted-by":"crossref","first-page":"e445","DOI":"10.1016\/S2468-2667(21)00100-6","article-title":"Improving diversity in research and trial participation: the challenges of language","volume":"6","author":"Willis","year":"2021","journal-title":"Lancet Public Health"}],"container-title":["Health Technology Assessment"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/njl-admin.nihr.ac.uk\/document\/download\/2051029","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.journalslibrary.nihr.ac.uk\/sites\/journalslibrary\/files\/journal_data\/GJHS2715\/GJHS2715.xml","content-type":"text\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/njl-admin.nihr.ac.uk\/document\/download\/2051029","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,15]],"date-time":"2026-05-15T12:28:16Z","timestamp":1778848096000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.journalslibrary.nihr.ac.uk\/hta\/GJHS2715"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,5]]},"references-count":90,"alternative-id":["10.3310\/GJHS2715"],"URL":"https:\/\/doi.org\/10.3310\/gjhs2715","relation":{},"ISSN":["2046-4924"],"issn-type":[{"value":"2046-4924","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,5]]},"assertion":[{"value":"This content has been made freely available to all.","name":"free","label":"Free to read"},{"value":"09-2016","name":"contractual_start_date","label":"contractual_start_date","group":{"name":"article_history","label":"Article History"}},{"value":"07-2023","name":"editorial_review_begun","label":"editorial review begun","group":{"name":"article_history","label":"Article History"}},{"value":"07-2025","name":"accepted_for_publication","label":"Accepted for publication","group":{"name":"article_history","label":"Article History"}}]}}