Sustained improvements in pain, mood, function and opioid use post interdisciplinary pain rehabilitation in patients weaned from high and low dose chronic opioid therapy

Abstract

Increased prescribing of opioids for chronic noncancer pain is associated with significant social costs, including overdose and addiction. In this context, there is interest in interdisciplinary chronic pain rehabilitation programs focusing on self-management and minimizing opioid use. This study examined outcomes of patients weaned from opioids in an ICPRP from 2007 to 2012. Participants included 413 patients on high dose chronic opioid therapy (COT; >100 mg), 528 on low dose COT, and 516 not on opioids (NO). Outcomes were assessed at discharge, 6, and 12 months posttreatment through self-report and chart review. One thousand one hundred ninety-four participants completed treatment (81.95%); 86.74% of those on opioids were weaned. High doses were less likely to complete (78.45%) than NO participants (85.27%; P < 0.05). Results showed immediate (P < 0.01) and sustained improvements (P < 0.05) in pain severity, depression, anxiety, and functional impairment with no group differences. Effect sizes ranged from medium to large (Cohen d values 0.57-1.96). Longitudinal medication use data were available for 319 no dose and 417 weaned participants; opioid resumption rates were 10.51% and 30.70% respectively. There were no differences in resumption between the high dose and low dose groups. Logistic regression analyses determined that opioid dose predicted neither treatment completion nor opioid resumption. Anxiety predicted completion, and functional impairment predicted opioid resumption within 1 year of discharge. Results suggest that patients on COT can be successfully weaned with long-term benefits in pain, mood, and function. Targeting anxiety and functional restoration may increase success rates.

Mu and delta opioid receptors play opposite nociceptive and behavioural roles on nerve‐injured mice

“…Altogether, these results contribute to explain the renowned lack of efficacy of MOP opioid agonists for the treatment of neuropathic pain (Bian et al, ; Huffman et al, ; Kimura, Obata, & Saito, ; Mao, Price, & Mayer, ; Rashid, Inoue, Toda, & Ueda, ; Wegert et al, ) and suggest the need for searching for alternatives to MOP opioid agonists. The identification of neuropathic pain as a pathological entity aggravated through MOP activity could be relevant to the reduction in the use of opioid drugs and to limit the clinical damage associated with the current opioid crisis (Volkow & McLellan, ).…”

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

“…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. In addition, considering the limitations of retrospective designs, there are studies that reviewed patients’ charts and reported improvements on pain, mood and function following interdisciplinary rehabilitation programs for CNCP, which included opioid tapering off or cessation (Murphy et al., ; Cunningham et al., ; Huffman 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. In addition, considering the limitations of retrospective designs, there are studies that reviewed patients' charts and reported improvements on pain, mood and function following interdisciplinary rehabilitation programs for CNCP, which included opioid tapering off or cessation (Murphy et al, 2013;Cunningham et al, 2016;Huffman et al, 2017). Another aspect of particular note was the fact that 58.3% of patients included in our study achieved stable treatment, which represents a high level of attainment compared to 34.5% of a previous available retrospective report in a similar sample (Schneider and Kirsh, 2010).…”

Using trajectory models to assess the effect of hydrocodone upscheduling among chronic hydrocodone users

“…On the one hand, the absence of such substitutions in among long‐term HCP users is counterintuitive, given that there are many alternative treatments for pain that could take the place of gaps in treatment created by hydrocodone discontinuation. On the other hand, studies of opioid titration among individuals using chronic opioids generally suggest that pain levels remain similar or decrease as opioid doses decline . In addition, in so far as some of the hydrocodone used occurred in settings with an unfavorable risk/benefit balance, the upscheduling may have decreased such use without a commensurate increase in the use of pharmacologic alternatives.…”

“…On the other hand, studies of opioid titration among individuals using chronic opioids generally suggest that pain levels remain similar or decrease as opioid doses decline. [27][28][29][30][31][32][33] In addition, in so far as some of the hydrocodone used occurred in settings with an unfavorable risk/benefit balance, 34 baseline may be an important predictor of a policy's impact. 36 The study, which compared states based on their level of opioid-related legislation, found greater variation in opioid outcomes among states with similar rates of legislation than across states that had different levels of legislation.…”