Evidence map›Paper›PMID 42192632›Full record

ArticleBMJ open2026

SAGE (safer analgesia): a protocol for a pragmatic cluster randomised controlled trial to reduce the use of high-risk medicines in people with chronic back and/or neck pain.

Christina Abdel Shaheed, Andrew J McLachlan, Stephanie Mathieson, Rowena Ivers, Philip J Clare, Fiona Blyth, Fiona Stanaway, Louisa Degenhardt, Danijela Gnjidic, Simon French and 19 more

Abstract readClinical Trial Protocol
PubMed Full text at PMC Publisher
In one paragraph

Article in BMJ open, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

0numbers the graph read from it
0cells of the map it votes in
0citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

0 citing papers in PubMed.

No citing paper in PubMed yet.

4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

29 authors.

Christina Abdel ShaheedSydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia christina.abdelshaheed@sydney.edu.au.ORCID http://orcid.org/0000-0003-1258-5125
Andrew J McLachlanSydney School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia.ORCID http://orcid.org/0000-0003-4674-0242
Stephanie MathiesonSydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia.ORCID http://orcid.org/0000-0002-7335-8842
Rowena IversGraduate School of Medicine, University of Wollongong, Wollongong, New South Wales, Australia.ORCID http://orcid.org/0000-0001-7847-9734
Philip J ClareSydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia.ORCID http://orcid.org/0000-0002-2009-7386
Fiona BlythSydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia.ORCID http://orcid.org/0000-0003-1128-6756
Fiona StanawaySydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia.ORCID http://orcid.org/0000-0003-2104-3010
Louisa DegenhardtNational Drug & Alcohol Research Centre (NDARC), Faculty of Medicine and Health, UNSW Sydney, Sydney, New South Wales, Australia.ORCID http://orcid.org/0000-0002-8513-2218
Danijela GnjidicSydney School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia.ORCID http://orcid.org/0000-0002-9404-3401
Simon FrenchDepartment of Chiropractic, Spinal Pain Research Centre, Macquarie University, Sydney, New South Wales, Australia.ORCID http://orcid.org/0000-0002-7061-7706
Rachel ThompsonSydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia.ORCID http://orcid.org/0000-0002-1009-0746
Sarah HilmerKolling Institute, Northern Sydney Local Health District and The University of Sydney, St. Leonards, New South Wales, Australia.ORCID http://orcid.org/0000-0002-5970-1501
Marina PinheiroSydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia.ORCID http://orcid.org/0000-0001-7459-5105
Gustavo C MachadoSydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia.ORCID http://orcid.org/0000-0002-8544-0448
Tim AustinPain Management Research Institute, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia.
Tania GardnerSydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia.ORCID http://orcid.org/0000-0001-6474-9983
Sweekriti SharmaSydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia.ORCID http://orcid.org/0000-0002-0919-8813
Alexandra BennettNew South Wales Therapeutic Advisory Group, Sydney, New South Wales, Australia.ORCID http://orcid.org/0000-0002-9900-5316
Monika BoogsPainaustralia Consumer Advisory Group, Canberra, Australian Capital Territory, Australia.
Jarrod McMaughPharmaceutical Society of Australia, Canberra, Australian Capital Territory, Australia.ORCID http://orcid.org/0000-0002-2000-2068
Lisa VizzaSydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia.ORCID http://orcid.org/0000-0002-0995-9635
Aron DownieDepartment of Chiropractic, Spinal Pain Research Centre, Macquarie University, Sydney, New South Wales, Australia.ORCID http://orcid.org/0000-0002-9888-3854
Marguerite TracyGeneral Practice Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia.ORCID http://orcid.org/0000-0003-1247-6412
Ria HopkinsNational Drug & Alcohol Research Centre (NDARC), Faculty of Medicine and Health, UNSW Sydney, Sydney, New South Wales, Australia.ORCID http://orcid.org/0000-0001-9822-7083
Rawa OsmanQUM Connect, Sydney, New South Wales, Australia.ORCID http://orcid.org/0000-0003-2090-8123
Richard I LindleyWestmead Applied Research Centre, The University of Sydney, Sydney, New South Wales, Australia.ORCID http://orcid.org/0000-0002-0104-5679
Chris HayesCollege of Health, Medicine and Wellbeing, University of Newcastle, Newcastle, New South Wales, Australia.ORCID http://orcid.org/0000-0001-7163-0390
Kirsten McCafferySydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia.ORCID http://orcid.org/0000-0003-2696-5006
Chris MaherSydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia.ORCID http://orcid.org/0000-0002-1628-7857

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

introductionChronic back and neck pain are commonly treated with opioid analgesics, gabapentinoids and benzodiazepines, despite their high-risk profile and potential limited efficacy. Deprescribing interventions (aimed at medicine reduction or cessation) have shown some effectiveness in reducing the use of these medications, but similar approaches tailored to individuals with complex chronic back and/or neck pain are lacking and urgently needed. This trial will evaluate the effect of the safer analgesia (SAGE) intervention (training of general practitioners (GPs) in deprescribing and support to deprescribe) on cessation and/or reduction of the target high-risk medicine (a benzodiazepine, gabapentinoid or opioid) for people with chronic back and/or neck pain. METHODS AND ANALYSIS: SAGE is a pragmatic cluster randomised trial that will be conducted with at least 30 general practices in Australia randomly assigned in a 1:1 ratio to the SAGE intervention or no intervention (usual care control group). The SAGE intervention is a GP-facing intervention comprising (i) training for GPs in deprescribing and access to deprescribing resources and (ii) deprescribing support-to assist the deprescribing process for their patients, GPs can conduct a long GP consultation (20-40-min duration), refer to trained physiotherapists for the provision of psychologically informed physiotherapy sessions and provide alternate pain management options including heat wrap and diclofenac gel. A total of 320 adult patient-participants experiencing chronic back and/or neck pain (≥ 3 months duration) prescribed a target high-risk medicine (benzodiazepine, gabapentinoid or opioid) persistently for this pain will be recruited via participating general practices. The primary outcome is cessation of dispensation of the trial participant's high-risk medicine (a benzodiazepine, gabapentinoid or opioid) prescribed by their trial GP. The primary time-point for the primary outcome will be 1-year post-enrolment with an observation window of the preceding 4 weeks. Secondary outcomes include self-reported outcomes such as pain, quality of life and adverse events. Analyses will follow an intention-to-treat approach with a nested economic evaluation and per-protocol analysis planned separately. ETHICS AND DISSEMINATION: The study received approval from the University of Sydney Human Research Ethics Committee (2024/HE001706). The results will be disseminated via publication in a peer-reviewed scientific journal, presentation at conferences and media. TRIAL REGISTRATION NUMBER: ANZCTR: ACTRN12625000953437.

Indexed as

AnalgesicsBack PainChronic PainDeprescriptionsGeneral PractitionersNeck PainAnalgesics, OpioidAustraliaBenzodiazepinesGabapentinHumansPragmatic Clinical Trials as TopicRandomized Controlled Trials as TopicAnalgesicsAnalgesics, OpioidBenzodiazepinesGabapentinBack painChronic PainPrimary Care

Identifiers

PMID42192632
PMCPMC13202041

What OpenQuestion holds

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.