Clinical Observation, Management, and Function Of low back pain Relief Therapies (COMFORT)

GPs will receive a baseline educational outreach visit of 0.5-1 hour duration and will also be given resources to implement the opioid stewardship intervention. The support material comprises patient education material “5 questions to ask about using opioids for back pain and osteoarthritis” (designed specifically for the trial) and heat wraps for pain relief (staged supply of up to 12 weeks). Patient participants will continue to be followed up until 1 year post enrolment. The topics covered during the education visit are: Judicious prescribing of opioids and potential harms of opioid use Pharmacological and non-pharmacological interventions that can be used as alternatives to opioids for back pain. These topics will be communicated using a 10-minute video designed specifically for the trial and also direct discussion between the GP and trial staff member. Every six months (until the recruitment target for each practice is met), researchers will schedule site visits involving a refresher training video summarising key messages on opioid stewardship and best practice management of back pain. Live online visits will be permitted in exceptional circumstances where face-to-face visits are not possible. Patient-participants will be provided with a Consumer Medicines Information (CMI) leaflet for the opioid medicine(s) prescribed at the enrolment visit either electronically or via post and will be advised to discuss any queries or concerns regarding the CMI leaflet with their doctor or pharmacist. This will be determined during the baseline follow-up between the researcher and the patient-participant and provided by the study team. The CMI leaflet is a readily available resource and can be accessed via the following link- "https://www.tga.gov.au/products/australian-register-therapeutic-goods-artg/consumer-medicines-information-cmi". GPs will additionally be given access to the publicly available NPS opioid tapering algorithm. The heat wraps are single use products intended to provide pain relief for people with low back pain. Patient-participants will be advised on the correct and safe use of heat wraps by the study GPs and study team. Patient-participants will be advised to wear these for 6-8 hours during the day and to have a 1-day break after 3 consecutive days of use. Patients may choose to use, or not use the heat wraps. A heat wrap diary will be used to document use. Note: The study will also schedule monthly follow-up calls with the study GPs to discuss trial progress, as well as 3 monthly site visits until the study achieves its recruitment target. The site visits will involve the review of trial documents and provide study support. Where required, GPs will be provided an additional supply of study materials (e.g., heat wraps, screening forms, etc). Live online visits will be permitted in exceptional circumstances where face-to-face visits are not possible.