Prescription Opioid Taper Support for Outpatients With Chronic Pain: A Randomized Controlled Trial

Abstract

Patients receiving long-term opioid therapy for chronic pain and interested in tapering their opioid dose were randomly assigned to a 22-week taper support intervention (psychiatric consultation, opioid dose tapering, and 18 weekly meetings with a physician assistant to explore motivation for tapering and learn pain self-management skills) or usual care (N=35). Assessments were conducted at baseline and 22 and 34 weeks after randomization. Using an intention-to-treat approach, we constructed linear regression models to compare groups at each follow-up. At 22 weeks, adjusted mean daily morphine-equivalent opioid dose (MED) in the past week (primary outcome) was lower in the taper support group, but this difference was not statistically significant (adjusted mean difference = −42.9 mg; 95% CI: −92.42, 6.62; p= 0.09). Pain severity ratings (0–10 NRS) decreased in both groups at 22 weeks, with no significant difference between groups (adjusted mean difference = −0.68; 95% CI: −2.01, 0.64; p = 0.30). The taper support group improved significantly more than usual care in self-reported pain interference, pain self-efficacy, and prescription opioid problems at 22 weeks (all p-values <0.05). This taper support intervention is feasible and shows promise in reducing opioid dose while not increasing pain severity or interference. [ClinicalTrials.gov Identifier: NCT01883882]

“I'm Not Gonna Pull the Rug out From Under You”: Patient-Provider Communication About Opioid Tapering

“…Further corroborating the importance of provider support during opioid tapering, a recent pilot study reported that patients randomized to a taper support intervention involving psychiatric consultation and weekly meetings with a physician assistant showed greater improvement on pain interference, pain self-efficacy, and perceived opioid problems, than control patients. 30 Support, further elaborated as nonabandonment in the current study, appears to be a critical element of communication about opioid tapering.…”

Tapering off long‐term opioid therapy in chronic non‐cancer pain patients: A randomized clinical trial

“…A Cochrane review on interventions for reduction of prescribed opioid use found only two studies, which were focused on non‐pharmacological strategies to reduce pain and, consequently, opioid use in CNCP (Windmill et al., ). Another randomized controlled trial recently tested a program to taper off L‐TOT in CNCP (Sullivan et al., ). The program consisted of psychiatric consultations, opioid dose tapering off and weekly sessions based on cognitive‐behavioural therapy, which was compared with usual care.…”

“…However, the taper off group improved significantly compared to the usual care group regarding self‐report of pain interference, pain self‐efficacy and prescription‐related problems at 22 weeks after randomization. Analyses of opioid misuse and opioid craving did not show differences between groups (Sullivan et al., ). Noteworthy, as demonstrated in our study, the groups did not differ regarding opioid dose and pain intensity, which indicated that L‐TOT in some of these patients may be dispensable.…”

“…Another randomized controlled trial recently tested a program to taper off L-TOT in CNCP (Sullivan et al, 2017). The program consisted of psychiatric consultations, opioid dose tapering off and weekly sessions based on cognitive-behavioural therapy, which was compared with usual care.…”

Sahaj Samadhi Meditation versus a Health Enhancement Program for depression in chronic pain: protocol for a randomized controlled trial and implementation evaluation

“…Change in opioid dosage, while certainly a safety and public health-oriented outcome, is not a patient-centered outcome. Previous studies examining opioid tapering strategies have suffered from poor recruitment as well as selection bias, perhaps reflecting lack of motivation and interest amongst patients in reducing opioid doses [41]. This has been seen specifically in other studies of nonpharmacological interventions for opioid dose reduction [42].…”