In the Journals

Opioid tapering does not increase pain intensity

A patient-centered opioid tapering approach helped patients with chronic pain reduce opioid use without increasing pain intensity, according to research published in JAMA Internal Medicine.

“The risks associated with prescription opioids are well described. Although reducing opioid use is a national priority, existing opioid tapering models use costly interdisciplinary teams that are largely inaccessible to patients and their physicians,” Beth D. Darnall, PhD, from the division of pain medicine at Stanford University School of Medicine, and colleagues wrote. “Patients and physicians need solutions to successfully reduce long-term prescription opioid dosages in settings without behavioral services.”

Darnall and colleagues studied the effect of voluntary, patient-centered opioid tapering in outpatients with noncancer related chronic pain not receiving behavioral treatment. A total of 110 patients (mean age, 51 years; 60% female) were enrolled in the study and were taught about the benefits associated with opioid reduction by their prescribing prescription. Over the course of 4 months, opioid dosages were slowly tapered.

Most participants (75%) consented to reducing their opioid dosages. Data on baseline demographics, along with information on opioid use, pain, marijuana use and psychosocial measures were collected from 68 of these participants.

Opioid dosages were reduced gradually to lessen negative physical and emotional reactions, withdrawal symptoms and to boost patient confidence. In the first month, opioid dosages were decreased up to 5% for two dose reductions at most. Then, in the second to fourth months, patients further reduced their use by as much as 10% per week.

A follow-up survey was completed by 51 participants at 4 months. Among these participants, there was a median duration of opioid use of 6 years and a baseline median morphine equivalent daily dose of 288 mg, which was reduced to 150 mg after 4 months.

Participants demonstrated a moderate median pain intensity. There was no increase in pain intensity or pain interference with opioid tapering. Starting dose, baseline pain intensity, years prescribed opioids and psychosocial variables did not predict the odds of an opioid dose reduction that was more than 50%.

“Combining patient education about the benefits of opioid reduction with a plan that reduces opioids more slowly than current tapering algorithms with close clinician follow-up may help patients engage and succeed in voluntary outpatient tapering,” Darnall and colleagues concluded. “Because our data are generated from a single pain clinic, studies are needed to assess how well our protocol would generalize to other types of patients and settings.” – by Alaina Tedesco

Disclosure: The authors report no relevant financial disclosures.

A patient-centered opioid tapering approach helped patients with chronic pain reduce opioid use without increasing pain intensity, according to research published in JAMA Internal Medicine.

“The risks associated with prescription opioids are well described. Although reducing opioid use is a national priority, existing opioid tapering models use costly interdisciplinary teams that are largely inaccessible to patients and their physicians,” Beth D. Darnall, PhD, from the division of pain medicine at Stanford University School of Medicine, and colleagues wrote. “Patients and physicians need solutions to successfully reduce long-term prescription opioid dosages in settings without behavioral services.”

Darnall and colleagues studied the effect of voluntary, patient-centered opioid tapering in outpatients with noncancer related chronic pain not receiving behavioral treatment. A total of 110 patients (mean age, 51 years; 60% female) were enrolled in the study and were taught about the benefits associated with opioid reduction by their prescribing prescription. Over the course of 4 months, opioid dosages were slowly tapered.

Most participants (75%) consented to reducing their opioid dosages. Data on baseline demographics, along with information on opioid use, pain, marijuana use and psychosocial measures were collected from 68 of these participants.

Opioid dosages were reduced gradually to lessen negative physical and emotional reactions, withdrawal symptoms and to boost patient confidence. In the first month, opioid dosages were decreased up to 5% for two dose reductions at most. Then, in the second to fourth months, patients further reduced their use by as much as 10% per week.

A follow-up survey was completed by 51 participants at 4 months. Among these participants, there was a median duration of opioid use of 6 years and a baseline median morphine equivalent daily dose of 288 mg, which was reduced to 150 mg after 4 months.

Participants demonstrated a moderate median pain intensity. There was no increase in pain intensity or pain interference with opioid tapering. Starting dose, baseline pain intensity, years prescribed opioids and psychosocial variables did not predict the odds of an opioid dose reduction that was more than 50%.

“Combining patient education about the benefits of opioid reduction with a plan that reduces opioids more slowly than current tapering algorithms with close clinician follow-up may help patients engage and succeed in voluntary outpatient tapering,” Darnall and colleagues concluded. “Because our data are generated from a single pain clinic, studies are needed to assess how well our protocol would generalize to other types of patients and settings.” – by Alaina Tedesco

Disclosure: The authors report no relevant financial disclosures.

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