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Key Points: Question: Among patients with chronic pain, does a multicomponent intervention consisting of group meetings, education, individual support, and skill-based learning reduce opioid use and improve pain interference with daily activities compared with usual care? Findings: In this multicentered, randomized clinical trial that included 608 participants with chronic pain due to nonmalignant causes from primary care settings in the UK, at 12-month follow-up, 29% of people in the intervention group, compared with 7% in the usual care group, discontinued opioids, but there were no statistically significant differences in pain interference with daily life activities between the 2 groups at 12 months. Meaning: Among patients with chronic pain due to nonmalignant causes, a group-based educational intervention significantly reduced opioid use had no effect on perceived pain compared with usual care. Importance: Opioid use for chronic nonmalignant pain can be harmful. Objective: To test whether a multicomponent, group-based, self-management intervention reduced opioid use and improved pain-related disability compared with usual care. Design, Setting, and Participants: Multicentered, randomized clinical trial of 608 adults taking strong opioids (buprenorphine, dipipanone, morphine, diamorphine, fentanyl, hydromorphone, methadone, oxycodone, papaveretum, pentazocine, pethidine, tapentadol, and tramadol) to treat chronic nonmalignant pain. The study was conducted in 191 primary care centers in England between May 17, 2017, and January 30, 2019. Final follow-up occurred March 18, 2020. Intervention: Participants were randomized 1:1 to either usual care or 3-day–long group sessions that emphasized skill-based learning and education, supplemented by 1-on-1 support delivered by a nurse and lay person for 12 months. Main Outcomes and Measures: The 2 primary outcomes were Patient-Reported Outcomes Measurement Information System Pain Interference Short Form 8a (PROMIS-PI-SF-8a) score (T-score range, 40.7-77; 77 indicates worst pain interference; minimal clinically important difference, 3.5) and the proportion of participants who discontinued opioids at 12 months, measured by self-report. Results: Of 608 participants randomized (mean age, 61 years; 362 female [60%]; median daily morphine equivalent dose, 46 mg [IQR, 25 to 79]), 440 (72%) completed 12-month follow-up. There was no statistically significant difference in PROMIS-PI-SF-8a scores between the 2 groups at 12-month follow-up (−4.1 in the intervention and −3.17 in the usual care groups; between-group difference: mean difference, −0.52 [95% CI, −1.94 to 0.89]; P =.15). At 12 months, opioid discontinuation occurred in 65 of 225 participants (29%) in the intervention group and 15 of 208 participants (7%) in the usual care group (odds ratio, 5.55 [95% CI, 2.80 to 10.99]; absolute difference, 21.7% [95% CI, 14.8% to 28.6%]; P <.001). Serious adverse events occurred in 8% (25/305) of the participants in the intervention group and 5% (16/303) of the participants in the usual care group. The most common serious adverse events were gastrointestinal (2% in the intervention group and 0% in the usual care group) and locomotor/musculoskeletal (2% in the intervention group and 1% in the usual care group). Four people (1%) in the intervention group received additional medical care for possible or probable symptoms of opioid withdrawal (shortness of breath, hot flushes, fever and pain, small intestinal bleed, and an overdose suicide attempt). Conclusions and Relevance: In people with chronic pain due to nonmalignant causes, compared with usual care, a group-based educational intervention that included group and individual support and skill-based learning significantly reduced patient-reported use of opioids, but had no effect on perceived pain interference with daily life activities. Trial Registration: isrctn.org Identifier: ISRCTN49470934 This randomized clinical trial compares the efficacy of a multicomponent, group-based, self-management intervention vs usual care in reducing opioid use and improving pain-related disability in patients taking strong opioids to treat chronic pain from nonmalignant causes. [ABSTRACT FROM AUTHOR]

The article focuses on the growing popularity of cathedrals in terms of worshippers and general visitors. It informs that the number of people attending services at Anglican cathedrals in England increased by 30 percent in the last 10 years. It also informs that growth in the number of worshippers at cathedrals is found in other parts of the Anglican Communion.

In 1726 Mary Toft claimed that she had given birth to rabbits, an event that led to much medical examination and a good deal of satire but surprisingly little religious commentary, apart from William Whiston's interpretation that she was a portent of the apocalypse. And yet Toft was repeatedly remembered and re-invoked throughout the century – along with several other miraculous, supernatural or wondrous events – in relation to broader public discussions about the boundaries between the natural and supernatural, between reason and revelation, with the result that each new ‘remembering’ paradoxically reiterated that those boundaries could not be definitively settled. [ABSTRACT FROM AUTHOR]