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

Published:November 28, 2016DOI:https://doi.org/10.1016/j.jpain.2016.11.003

      Highlights

      • A taper strategy for outpatients receiving long-term opioid therapy for chronic pain is needed.
      • Thirty-five subjects were randomized to a 22-week taper support intervention or usual care.
      • Subjects randomized to taper support achieved lower opioid daily doses without an increase in pain.

      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 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% confidence interval, −92.42 to 6.62; P = .09). Pain severity ratings (0–10 numeric rating scale) decreased in both groups at 22 weeks, with no significant difference between groups (adjusted mean difference = −.68; 95% confidence interval, −2.01 to .64; P = .30). The taper support group improved significantly more than the usual care group in self-reported pain interference, pain self-efficacy, and prescription opioid problems at 22 weeks (all P-values < .05). This taper support intervention is feasible and shows promise in reducing opioid dose while not increasing pain severity or interference.

      Perspective

      In a pilot randomized trial comparing a prescription opioid taper support intervention to usual care, lower opioid doses and pain severity ratings were observed at 22 weeks in both groups. The groups did not differ significantly at 22 weeks in opioid dose or pain severity, but the taper support group improved significantly more in pain interference, pain self-efficacy, and perceived opioid problems. These results support the feasibility and promise of this opioid taper support intervention.

      Key words

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