Towards Sex- and Gender-Sensitive Pain Management: Participatory Development of the GESCO Intervention for Chronic Non-Cancer Pain and Long-Term Opioid Therapy in Primary Care

Alexandra Piotrowski,1 Alexandra Schmidt,1 Neele Kufeld,2 Christine Kersting,1 Veronika Bencheva,3 Birgitt Wiese,4 Ottomar Bahrs,5 Christina Hunger-Schoppe,6 Michaela Maas,1,2 Jordan Preuss,3 Johannes Maximilian Just,1 Klaus Weckbecker,2 Petra Thürmann,3,7 Achim Mortsiefer1 On behalf of the GESCO study group1Chair of General Practice II and Patient-Centeredness in Primary Care, Institute of General Practice and Primary Care (iamag), Faculty of Health, Witten/Herdecke University, Witten, Germany; 2Chair of General Practice I and Interprofessional Care, Institute of General Practice and Primary Care (iamag), Faculty of Health, Witten/Herdecke University, Witten, Germany; 3Chair of Clinical Pharmacology, Faculty of Health, Witten/Herdecke University, Witten, Germany; 4IT Services Applications, Science & Laboratory, MHH Information Technology, Hannover Medical School, Hannover, Germany; 5Dachverband Salutogenese e.V., Göttingen, Germany; 6Chair of Clinical Psychology and Psychotherapy, Faculty of Health, Witten/Herdecke University, Witten, Germany; 7Philipp Klee-Institute of Clinical Pharmacology, Helios University Hospital Wuppertal, Wuppertal, GermanyCorrespondence: Alexandra Piotrowski, Chair of General Practice II and Patient-Centeredness in Primary Care, Institute of General Practice and Primary Care (iamag), Faculty of Health, Witten/Herdecke University, Witten, Germany, Email [email protected]: Chronic non-cancer pain (CNCP) is commonly managed in primary care with long-term opioid therapy (LTOT), despite limited effectiveness and substantial risks. Sex and gender shape pain experiences, treatment responses, and health outcomes, yet are rarely addressed in chronic pain interventions. This study aims to inform primary care pain management by addressing opioid-related harms, gender-based inequities, and the integration of biopsychosocial approaches.Methods: The development of the GESCO intervention was guided by the updated UK Medical Research Council (MRC) Framework for complex interventions. A participatory, theory-informed, and evidence-based approach was employed. Core development steps included literature reviews, qualitative interviews with patients and GPs, and a collaboratively developed Theory of Change (ToC). Intervention modules and evaluation tools were co-created and piloted with the stakeholders.Results: The GESCO intervention is a structured, gender-sensitive, multi-component GP consultation to improve care for patients with chronic pain and LTOT. Two 30-minute consultations integrate narrative medicine, expectation management, medication review, empowerment strategies, and tools such as the Positive Health tool and Social Network Mapping. Implementation is supported by a two-day GP training program, a toolbox of practical resources, and a patient brochure, a manual on sex-/gender-sensitive pharmacotherapy, and follow-up case conferences. Intervention design and evaluation is guided by a ToC framework, drawing on the COM-B model by Michie et al.Conclusion: GESCO represents a theory-informed intervention that aims to integrate gender sensitivity into a structured consultation model for chronic pain care in primary care settings. Its participatory development process is intended to support applicability in routine practice. In a subsequent stage of the project, GESCO will be piloted in ten practices with 40 patients to examine feasibility and explore preliminary effects.Keywords: long-term opioid therapy, chronic non-cancer pain, general practice, sex- and gender-sensitive care, theory of change, intervention development, implementation