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Reducing patient reliance on opioids

Harbinder Sandhu is an Associate Professor of Health Psychology at WMS and was recently featured in a list of 350 inspirational Sikh women. We met up with her to find out more about her research at Warwick Medical School and her role as a health psychologist.

How did you come to work in health psychology?

I studied psychology for my undergraduate degree and fairly quickly decided that health psychology was something that particularly interested me. I studied health psychology for my master’s before completing a doctorate at Staffordshire University, which I finished in 2008.

I joined Warwick Medical School in 2004 as a researcher in primary care and the research development team. During this time I was able to build my research skills in doctor-patient communication, as well as completing my doctorate. When I finished my doctorate I secured an assistant professorship role at WMS, continuing to establish my own research portfolio while leading the health psychology module on the MB ChB. During this time I also combined my academic role at the university with a clinical role (health psychologist) in chronic pain management in the NHS.

In 2011, I joined the Warwick Clinical Trials Unit, which gave me the opportunity to map my clinical work and my research interests, applying health psychology and behaviour change to the design of complex interventions in the area of musculoskeletal disorders and pain management. My research now expands beyond this, applying behaviour change and health psychology to neurological conditions, insomnia and pain.


Congratulations on being named on the list of #350sikhwomen! Can you tell us a bit more about it?

The #350sikhwomen project was run by The Sikh Network in January to mark the 350th anniversary of the birth of Guru Gobind Singh, the tenth Sikh Guru. The Network ran a social media campaign celebrating the sacrifices, contributions and achievements of 350 Sikh women they feel are helping to inspire future generations. There were different categories such as women in sport, politics and media, and I was included in the education/academic category. It was really lovely to be featured and so unexpected! Several people have got in touch with me since the list was published, so it’s been great to make some new connections.

Projects like this are a great way to highlight the achievements of women in the workplace - do you think there are still significant challenges for women working in medicine?

I think there are still challenges for women in certain areas of medicine, but it’s nice to see that things are going in the right direction. Schemes such as Athena SWAN are very important and I’m pleased to work somewhere that values it.

You’ve recently secured a National Institute of Health Research (NIHR)-funded multi-centre trial aiming to help people reduce their reliance on opioids (strong pain relief medication). Why is the study so important?

Nearly 8 million people in England have moderate to severe chronic pain, which clearly has a significant impact on their lives. Treatment with opioids is often recommended, but the side effects of taking these medications can often outweigh the benefits of long term use, so we need to be looking at alternatives.

There is no evidence that shows long-term benefits of taking opioid medication on pain relief. Prescribing has increased dramatically over the past few years and it has recently been suggested that the UK is facing an opioid epidemic! So the aim of this study is to test the effectiveness and cost effectiveness of a self-management programme, helping people to reduce their opioid consumption and improve their quality of life.

What does the study involve?

It’s a 39-month trial, and participants are randomly allocated to one of two groups. Those in the first group continue to receive usual care from their GP and are sent a manual containing advice about how to manage long-term pain and information about the side effects of taking opioids to use as a learning tool. They also receive a relaxation CD so that they can practise relaxation techniques.

Participants in the second group receive the same as those in the first group but are also invited to take part in a short three-day course. During the course, participants are put in groups with others who use opioids to manage their chronic pain, and think about their own lifestyle, experiences and behaviours. The course involves education about a range of topics, including understanding pain and coping and relaxation techniques. The course is delivered by a trained I-WOTCH nurse and a lay person with chronic pain and experience of coming off their opioid medication. Participants are supported by the I-WOTCH nurse and receive individual follow-up for their actual tapering and withdrawal.

All participants are asked to complete a weekly diary for the first four months of the study. They then complete follow-up questionnaires at four, eight and 12 months about their pain levels, opioid use and daily activities.

It’s a multi-centre trial (North East London, Warwick and North East England). There are regional differences in opioid prescribing, with North East England being one of the highest prescribing regions in the UK. I’m fortunate to have an excellent team for the project with a range of expertise, from clinicians to academics and lay people with chronic pain and experience of opioid withdrawal. Professor Sam Eldabe is co-chief investigator and is based at South Tees Hospital.

What do you hope the study will achieve?

I hope the study will show that people can be motivated to reduce their opioid medication and are able to manage their pain using self-management techniques without the reliance on strong pain medication. I also hope the study helps raise awareness amongst health professionals and people with chronic pain of the dangers we face because of high prescribing of opioid medications and how this can be managed effectively.

What’s your favourite part of your role?

My favourite part of the role is being able to do something I really enjoy! Applying health psychology to complex clinical trials and mapping my clinical work to my academic work has helped strengthen my skill set and given me direction and confidence in what I do. Working in the Clinical Trials Unit has given me opportunities to lead - as well as collaborate on - some really interesting trials.

Another area of behavioural research I am enjoying developing at the moment is in dystonia, the third most common movement disorder after essential tremor and Parkinson’s disease. Having already secured seed funding and published results of a complex intervention (proof of study design), combining mindfulness and cognitive behavioural principles for the self-management of dystonia, I’m keen to secure funding to lead a programme of work in this area with an aim to completing a main randomised controlled trial.

I enjoy linking with different research teams (nationally and internationally), as well as staff and students here at the WMS. I currently lead aspects of health psychology teaching on the MB ChB, which means I get to interact with our medical students.

Do you have any advice for people thinking about becoming a health psychologist?

Do it! Health psychology is a great area to work in and I think it’s increasingly being seen as a central part of medical research. It’s come a long way over the last 20 years. Here at the Medical School I lead a network of health psychologists, which brings together expertise from different divisions as well as the wider University. The number of health psychologists in research at Warwick continues to grow.

If you’re thinking of health psychology as a possible career I would advise you to do your research around it and network as much as you can. Take any opportunities that open up to you and more opportunities will come your way.

Harbinder