Reducing the use of opioids by patients with chronic pain: an effectiveness study with long-term follow-up

Abstract

This study addresses the problem of long-term opioid use by chronic pain patients. The study involved a secondary analysis of unanalyzed data from a published study of 2 versions of cognitive-behavioural therapy-based interdisciplinary treatment for chronic pain. In this study, we examined whether the use of opioids by 140 chronic pain patients could be ceased sustainably over 12 months after participation in the comprehensive interdisciplinary pain management program aimed at enhancing pain self-management. On admission to the treatment, there were no significant differences between those patients taking or not taking opioids on usual pain, pain interference in daily activities, pain-related disability, depression severity, as well as in pain cognitions. After the treatment, the use of opioids was significantly reduced, both in numbers taking any and in mean doses, and these gains were maintained over the 12-month follow-up. Finally, cessation of opioids during treatment was associated with more substantial and consistent improvements in usual pain, depression severity, pain interference, pain-related disability, and pain cognitions, relative to those who reduced their opioids but did not cease them. These findings support the idea of using training in pain self-management strategies as a viable alternative to long-term opioid use by patients with chronic pain.

Benefits and Harms of Long-term Opioid Dose Reduction or Discontinuation in Patients with Chronic Pain: a Rapid Review

“…Among 3,155 potentially relevant citations, we included 49 studies-1 systematic review (Frank et al), 8 34 studies included in that systematic review,, and 14 new studies identified in our literature search. [50][51][52][53][54][55][56][57][58][59][60][61][62][63] A total of 40,245 patients are included in the 14 new studies.…”

“…We prioritized evidence synthesis of: 1) studies conducted in a VHA setting or other outpatient settings; 2) studies that addressed serious harms such as overdose and suicide; and 3) studies that included enough detail regarding patient and tapering characteristics to evaluate the applicability of findings to VHA populations and settings. Nineteen studies (Table 1) (2 RCTs, 18, 50 6 controlled observational studies, 54,56,[60][61][62][63] and 11 uncontrolled observational studies) 27,30,32,34,36,40,55,[57][58][59]65 met these criteria, which we refer to as "prioritized studies." The remaining studies either had low applicability to VHA or outpatient settings or included patients or interventions that were not well-described.…”

Perspectives of Pain Specialists, Patients, and Family Members on Long-Term Opioid use for Chronic Non- Cancer Pain: A Qualitative Study

“…[42] Furthermore, training patients to use pain self-management strategies was able to significantly reduce long-term opioid use in patients with chronic pain. [43] Enhanced continuing pain education is therefore essential for health care professionals, to fill gaps in their knowledge and increase competencies related to pain management.…”

mHealth Interventions to Support Prescription Opioid Tapering in Patients With Chronic Pain: Qualitative Study of Patients’ Perspectives

“…Emerging data suggest that when patients volunteer to taper, a patient-centered, multimodal approach involving pain education, nonpharmacological pain self-management strategies, routine follow-up with a trusted health care provider, and support for coping with pain and withdrawal symptoms may improve outcomes [9,[14][15][16][17][18]. However, patients face a number of obstacles in accessing comprehensive opioid tapering support.…”