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

Ramos Silva, A, Montgomery, C ORCID: 0000-0003-2805-5807, Frank, B ORCID: 0000-0001-5405-4942, Herron, K and Poole, H ORCID: 0000-0002-6165-3764 (2026) Behaviour change interventions to reduce opioids in chronic non-cancer pain in primary care: A systematic review and mapping of behavior change techniques. Medicine, 105 (32). ISSN 0025-7974

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Abstract

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.

Item Type:	Article
Uncontrolled Keywords:	chronic pain; opioid; primary care; psychosocial interventions; Humans; Analgesics, Opioid; Behavior Therapy; Primary Health Care; Randomized Controlled Trials as Topic; Chronic Pain; chronic pain; opioid; primary care; psychosocial interventions; Humans; Analgesics, Opioid; Chronic Pain; Primary Health Care; Behavior Therapy; Randomized Controlled Trials as Topic; 32 Biomedical and Clinical Sciences; 3202 Clinical Sciences; Chronic Pain; Clinical Trials and Supportive Activities; Pain Research; Women's Health; Drug Abuse (NIDA only); Health Services; Substance Misuse; Clinical Research; 7.1 Individual care needs; Generic health relevance; Humans; Analgesics, Opioid; Chronic Pain; Primary Health Care; Behavior Therapy; Randomized Controlled Trials as Topic; 1103 Clinical Sciences; Arthritis & Rheumatology; 32 Biomedical and clinical sciences; 3202 Clinical sciences
Subjects:	B Philosophy. Psychology. Religion > BF Psychology R Medicine > R Medicine (General) R Medicine > RM Therapeutics. Pharmacology
Divisions:	Psychology (from Sep 2019)
Publisher:	Wolters Kluwer Health
Date of acceptance:	23 July 2026
Date of first compliant Open Access:	21 September 2026
Date Deposited:	21 Sep 2026 10:56
Last Modified:	21 Sep 2026 10:56
DOI or ID number:	10.1097/MD.0000000000050106
URI:	https://researchonline.ljmu.ac.uk/id/eprint/29477

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