Improving outcomes for patients with opioid-treated persistent non-cancer pain: a proactive clinical pharmacist-led primary care intervention (PROMPPT intervention).ACRONYM: Pharmacist-led intervention to Reduce inappropriate use of Opioid Medicines and optimise Persistent Pain Therapy (PROMPPT)
Clinical pharmacists will take the lead on helping patients with persistent pain safely reduce their long-term opioid use, through a new intervention called PROMPPT being tested across GP practices in England. This matters because opioid prescribing for persistent non-cancer pain has risen sharply despite weak evidence of long-term benefit and clear safety risks. Many patients remain on high doses with little support to taper off. The PROMPPT intervention aims to fill that gap by embedding clinical pharmacists—already present in many practices—to deliver structured, personalised reviews and gradual dose reduction. If the trial succeeds, the NHS could adopt a scalable, pharmacist-led model that reduces opioid dependence without worsening pain or quality of life. The research includes a full health economic evaluation, so funders will know whether the approach saves money as well as improves outcomes. For patients, this could mean fewer side effects, less risk of dependence, and better pain management overall—without being left to manage withdrawal alone.
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Background: Opioid prescribing for persistent pain has increased despite limited evidence of long-term effectiveness and important safety concerns. Clinical pharmacists play an increasing role in managing patients on long-term medicines in general practice. Aim: Develop and test a clinical pharmacist–led intervention (PROMPPT) to support patients with persistent pain to safely reduce opioids, without increasing pain/pain-related interference. Workstream 1: Development of PROMPPT intervention and training. Objectives: Determine PROMPPT intervention components, clinical pharmacist training needs and potential barriers to delivery using best practice guidelines, stakeholder engagement, qualitative methods and theory. Co-design prototype PROMPPT intervention with stakeholders and refine through cycles of in-practice testing. Qualitative methods: Investigate experiences and perspectives regarding opioids for persistent pain and potential barriers/facilitators in delivering a clinical pharmacist-led intervention to reduce opioids using: Semi-structured interviews with opioid-treated patients, clinical pharmacists and GPs (each group, n=15 or until category saturation achieved). Netnography/online qualitative research, via researcher-administered blog generating 12 (weekly) online discussions (informed by themes emerging from interviews and extant online data) among people with persistent pain. Clinical pharmacist focus groups (n=2) to identify clinical pharmacist training needs and barriers/facilitators in delivering PROMPPT. In-practice testing of prototype PROMPPT reviews including cognitive think-aloud interviews (n=3 practices, n=3 clinical pharmacists, n=3 cycles, 15 patients). Analysis: Framework approach. Output: Finalised prototype PROMPPT intervention. Workstream 2: Non-randomised feasibility study with mixed methods process evaluation Objectives: Investigate acceptability/feasibility of PROMPPT and main trial design. Methods: Eligible patients, prescribed opioids ≥6months, identified from electronic records (n=80, from 4 practices across 2 centres), invited to participate in evaluation of primary care pain management ( research evaluation ) and, separately, to attend clinical pharmacist (PROMPPT) review (around 30 minutes, personalised, multifaceted, follow-up and GP collaboration as needed). Data collection: self-reported participant questionnaires (baseline, 3-months), PROMPPT template, audio-recorded consultations (n=20), qualitative interviews (n=15 patients, all clinical pharmacists, n=4 GPs). Quantitative analysis: Rates of intervention uptake/follow-up attendance and acceptability/credibility scores. Research evaluation recruitment/retention. PROMPPT uptake by patients not providing study data. Qualitative analysis: Framework approach. Outputs: Refinement/modification of intervention and/or trial processes for main trial. Workstream 3: Pragmatic multicentre, cluster RCT incorporating internal pilot, health economic and process evaluations. Objectives: Determine clinical and cost-effectiveness of providing PROMPPT in reducing opioid use, without increasing pain/pain-related interference, compared with usual care. Methods: Eligible patients (n=1040) identified from n=24 GP practices (3 centres). Practices randomised 1:1 intervention/control. Eligible patients (both arms) sent identical research evaluation study pack. Intervention practices: patients invited for PROMPPT. Control practices: usual care. Primary outcomes: (1) Reduction in opioid use (≥25% reduction daily morphine-equivalent dose), (2) Non-inferiority on Brief Pain Inventory score (at 12 months). Secondary outcomes include pain, pain-related interference, quality of life, side-effects, self-efficacy, medication use, healthcare utilisation. Practice-level analgesic prescribing. Primary intention-to-treat analysis: multilevel logistic (opioid reduction
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