Prolonged cessation of chronic opioid analgesic therapy: a multidisciplinary intervention

Changes in Psychological Outcomes after Cessation of Full Mu Agonist Long-Term Opioid Therapy for Chronic Pain

“…De-identified data were collected via a retrospective review of electronic medical records (EMR) from October 2017 to December 2019, comparing the pre- and post-psychological assessment questionnaire scores of 98 patients with CNCP who successfully ceased LTOT use through participation in a previously described, group multidisciplinary program [ 14 , 30 ]. Questionnaires were given to each patient at orientation and at graduation.…”

“…The multidisciplinary program [ 14 , 30 , 31 ] operated as a stand-alone intervention within a larger, multi-center, private practice specializing in CNCP in Northern California. Two centers and clinical teams participated in program administration under one medical director.…”

“…Participants were diagnosed with CNCP from any etiology; had used daily LTOT at the time of admission for a minimum of a year’s duration (although most reported much longer use), or struggled to maintain recent opioid cessation after prolonged use; had previously tried and failed or plateaued in regards to opioid weaning. Program recruitment, exclusion criteria, and criteria for referral have been described elsewhere [ 14 , 30 , 31 ]. Long-term opioid therapy was defined as any form of prescribed oral or transdermal long- or short-acting pharmaceutical opioid obtained while under the care of a physician.…”

“…Long-term opioid therapy was defined as any form of prescribed oral or transdermal long- or short-acting pharmaceutical opioid obtained while under the care of a physician. At admission, participants used LTOT amounts as high as 600 daily oral morphine milligram equivalents (MME) (median, 60 MME; 25% quartile, 36.5 MME; 75% quartile, 90 MME; interquartile range, 53.5 MME) [ 30 ].…”

“…The primary aim of this study was to identify changes between psychological assessment questionnaires, pre and post LTOT cessation, for patients with CNCP. We present findings from a retrospective analysis in a cohort of patients with CNCP who were successfully able to cease LTOT through participation in a group, multidisciplinary program [ 14 , 30 ] that offered therapeutic options that included buprenorphine. This study took place prior to reports of declining clinical outcomes after LTOT cessation, which notably did not include the option of buprenorphine in care planning [ 2 , 3 , 4 , 5 , 6 ].…”