Examining the effectiveness and feasibility of RADAR (Reducing Analgesic Drugs and Re-engaging) opioid tapering group program – Pilot Study

We will conduct a pragmatic mixed methods research project where data collection for both the quantitative and qualitative parts will be carried out in parallel. For the quantitative part of the study, we will conduct a parallel group intervention study. For the qualitative part, we will conduct in-depth interviews of study participants selected purposively. Thus, a subset of client volunteers participating in the quantitative part of the study will also take part in the qualitative assessment. The study participants will belong to the following three groups based on their self-selection. Group 1; clients attending a practitioner supported group opioid reduction programme; RADAR (Reducing Analgesic Drugs and Re-engaging) Group 2; Individual pharmacist support or Group 3; GP care. Participant selection will be pragmatic, as this is a pilot study with the aim of determining the feasibility, acceptability and effectiveness of RADAR. This will allow us to determine a priori sample sizes that will allow a future study to be adequately powered. All patients referred to NQPPMS first attend our introductory pain education program. The introductory programme consists of an initial 90 minute education session on pain neurophysiology and pain management techniques in a group of 10 - 20 patients and a second "Screen and Skills" 2 hour exercise, education and mobility assessment group of up to 10 patients. These are delivered by medical and allied health staff at the Ross river Road clinic as well as at outreach clinics in Cairns, Mackay and Mount Isa. All clients referred to our pain service on an OMEDD greater than 60mg will be seen by a pain specialist for a routine 1 hour NQPPMS new patient appointment, The pain specialist will make a recommendation to the client’s GP for a reduction in opioid, including a tapering plan to limit withdrawal symptoms and seek their consent to enrol in the research project either in Group 1 RADAR, Group 2; Individual pharmacist support or Group 3; GP care. Patients with a history of aberrant drug use may be referred to ATODS, according to clinicians judgement and patient wishes. For patients selecting the RADAR option, NQPPMS administration staff will invite 6-10 participants per group to attend three 90 minute sessions as follows Session 1; Motivational interviewing, discussion around hopes and expectations to elicit commitment to tapering Education about: 1) the limited evidence of the long term efficacy of opioids in chronic non-cancer pain 2) risks and side-effects associated with chronic opioid therapy (COT) 3) possible opioid withdrawal symptoms and ways to manage these Determine OMEDD EQ5D5L Session 2; ( 2 weeks after session 1) Introduction to basic withdrawal management skills including relaxation, distraction, activity scheduling, mindfulness and thought management. Agree plan for opioid reduction to be communicated with GP. Session 3; (6 weeks after session1) Sleep management, Review of progress, Provide support, Group discussion encouraged Determine OMEDD 3 month review 90mins Review of progress, Trouble-shooting, Determine OMEDD EQ5D5L Our pharmacist will liaise with patients' GP's to verify OMEDD doses. To monitor adherence to the treatment intervention, patients will record their opioid doses and strategies they can use to manage withdrawal symptoms and pain in their diary "My Opioid Reduction Plan." Page 1 allows patients to record dose, withdrawal symptoms and improvements noted. Page 2 records strategies that patients have found useful.