Behaviour change interventions to reduce opioids in chronic non-cancer pain in primary care: A systematic review and mapping of behavior change techniques.

BACKGROUND

Despite limited efficacy, patients are prescribed opioids for chronic non-cancer pain (CNCP). Guidelines recommend supporting the safe tapering of opioid prescriptions for these patients. This usually occurs in primary care, so there is a need to ascertain the efficacy of interventions implemented in this setting. This review aims to evaluate the effectiveness of interventions to reduce opioids in CNCP patients in primary care and identify effective behavior change techniques (BCTs).

METHODS

A comprehensive search was conducted in Medline, Cumulative Index to Nursing and Allied Health Literature and Web of Science databases in May 2023 using the MESH terms: "Chronic pain," "opioid," "primary care," and "psychosocial interventions." Manual searches were conducted in 7 systematic reviews. Psychosocial intervention trials with a control group were eligible for the review. Studies were excluded if opioid dosages were not reported.

RESULTS

Thirteen studies were included - 7 randomized controlled trials and 6 cohort studies with a total of 3130 patients. Upon quality assessment, one study was deemed strong, two were moderate, and ten were of weak quality. Eight interventions demonstrated success in opioid tapering in primary care settings. A broad spectrum of intervention techniques were identified, with Behaviour Substitution consistently applied in the effective interventions.

CONCLUSION

We determined the effective BCTs used across these trials to guide design and implementation of future interventions. This is the first review to identify BCTs that may contribute to supporting patients in tapering opioids in CNCP in primary care settings. Limitations include high heterogeneity in study designs and in the reporting of techniques used.