Investigating the effectiveness of a behavioural opioid weaning programme in primary care.

The School of Natural Sciences and Psychology at Liverpool John Moores University (https://www.ljmu.ac.uk/about-us/faculties/faculty-of-science/school-of-natural-sciences-and-psychology) is offering one 3-year Ph.D. studentship to undertake research to investigate the effectiveness and cost-effectiveness of a behavioural programme for weaning patients off high dose opioids.

Background:

The primary aim of this project is to investigate the effectiveness of discontinuing or reducing high-dose opioid treatment and instituting alternative drug or non-drug therapies, for patients with chronic non-malignant pain. The prevalence of chronic non-malignant pain (CNMP) is estimated at 20% in the adult population; 7% of patients have severe pain. In recent years, a continuous and significant increase of opioid prescribing in the UK has been observed. 16.1% of patients taking opioids had a cancer diagnosis but the majority of patients had non-malignant pain 83.9%. However, many patients take opioids for CNMP without any long-term benefit due to tolerance development and they do not benefit from improvement in function or quality of life. For patients such as this, there is little support to reduce or stop using high dose opioids in primary care and they continue to use them despite a lack of efficacy.

The present study proposes an audit of opioid prescribing in a single Clinical Commissioning Group (CCG). This will involve performing a literature search and analysing data on opioid prescribing in a range of primary care providers. Following on from this, a small number of GP surgeries will be invited to take part in a pre-existing training programme aimed at reducing opioid use. Overall, the programme of research will evaluate current practise and propose a staged intervention for the reduction/cessation of high-dose opioids, that can be utilised in primary care with minimal resources.

Skills required:

We are seeking a highly motivated student, who also has personal skills that are conducive to accessing and conducting research with patient groups and service providers (with the support of the supervisory team).

Applicants must hold a first or upper-second class undergraduate, or a Master’s, degree in psychology or a related discipline. The successful applicant should have a general understanding of quantitative and qualitative methods, and preferably experience of/interest in conducting research in primary care. An excellent standard of verbal and written English is essential as the successful student will be expected to publish from their PhD studies, contribute to relevant publications from the supervisory team as a co-author, and work towards presenting their findings in relevant fora.

The student will be expected to develop the research plan with the support of supervisors. In addition to literature review and scoping exercises (e.g. problem statement, theoretical elaboration) relevant work will proceed through linked stages, and might include:

i) An audit of prescribing practises among GPs in a single CCG to assess the size of the problem and identify GP surgeries who prescribe the most opioids.

ii) The coordination of a training programme for GPs who are on the higher end of opioid prescribing.

iii) The evaluation of a staged intervention to wean patients with CNMP off opioids and support them in effective self-management of pain.

Supervision:

Other members of the supervisory team will be Dr Helen Poole from the school of Natural Sciences and Psychology (https://www.ljmu.ac.uk/about-us/staff-profiles/faculty-of-science/natural-sciences-and-psychology/helen-poole), Professor Harry Sumnall from the LJMU Public Health Institute (https://www.ljmu.ac.uk/about-us/staff-profiles/faculty-of-education-health-and-community/public-health-institute/harry-sumnall), and Dr Bernhard Frank, Consultant in Pain Medicine at The Walton Centre, Liverpool (https://www.thewaltoncentre.nhs.uk/Consultant/8/Dr-Bernhard-Frank.html).