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

Published:November 28, 2016DOI:


      • 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.


      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.


      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.

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        • Banta-Green C.J.
        • Von Korff M.
        • Sullivan M.D.
        • Merrill J.O.
        • Doyle S.R.
        • Saunders K.
        The prescribed opioids difficulties scale: A patient-centered assessment of problems and concerns.
        Clin J Pain. 2010; 26: 489-497
        • Bastien C.H.
        • Vallieres A.
        • Morin C.M.
        Validation of the Insomnia Severity Index as an outcome measure for insomnia research.
        Sleep Med. 2001; 2: 297-307
        • Califf R.M.
        • Woodcock J.
        • Ostroff S.
        A proactive response to prescription opioid abuse.
        N Engl J Med. 2016; 374: 1480-1485
        • Callahan C.M.
        • Unverzagt F.W.
        • Hui S.L.
        • Perkins A.J.
        • Hendrie H.C.
        Six-item screener to identify cognitive impairment among potential subjects for clinical research.
        Med Care. 2002; 40: 771-781
      1. Centers for Disease Control and Prevention National Center for Health Statistics: Multiple cause-of-death data, 1999-2013. Available at: Accessed September 11, 2016

        • Cherkin D.C.
        • Sherman K.J.
        • Balderson B.H.
        • Cook A.J.
        • Anderson M.L.
        • Hawkes R.J.
        • Hansen K.E.
        • Turner J.A.
        Effect of mindfulness-based stress reduction vs cognitive behavioral therapy or usual care on back pain and functional limitations in adults with chronic low back pain: A randomized clinical trial.
        JAMA. 2016; 315: 1240-1249
        • Cleeland C.S.
        • Ryan K.M.
        Pain assessment: Global use of the Brief Pain Inventory.
        Ann Acad Med Singapore. 1994; 23: 129-138
        • Cunningham J.L.
        • Evans M.M.
        • King S.M.
        • Gehin J.M.
        • Loukianova L.L.
        Opioid tapering in fibromyalgia patients: Experience from an interdisciplinary pain rehabilitation program.
        Pain Med. 2016; 17: 1676-1685
        • Edlund M.J.
        • Austen M.A.
        • Sullivan M.D.
        • Martin B.C.
        • Williams J.S.
        • Fortney J.C.
        • Hudson T.J.
        Patterns of opioid use for chronic noncancer pain in the Veterans Health Administration from 2009 to 2011.
        Pain. 2014; 155: 2337-2343
        • Ehde D.M.
        • Dillworth T.M.
        • Turner J.A.
        Cognitive-behavioral therapy for individuals with chronic pain: Efficacy, innovations, and directions for research.
        Am Psychol. 2014; 69: 153-166
        • Gwira Baumblatt J.A.
        • Wiedeman C.
        • Dunn J.R.
        • Schaffner W.
        • Paulozzi L.J.
        • Jones T.F.
        High-risk use by patients prescribed opioids for pain and its role in overdose deaths.
        JAMA Intern Med. 2014; 174: 796-801
        • Humeniuk R.
        • Ali R.
        • Babor T.F.
        • Farrell M.
        • Formigoni M.L.
        • Jittiwutikarn J.
        • de Lacerda R.B.
        • Ling W.
        • Marsden J.
        • Monteiro M.
        • Nhiwatiwa S.
        • Pal H.
        • Poznyak V.
        • Simon S.
        Validation of the Alcohol, Smoking and Substance Involvement Screening Test (ASSIST).
        Addiction. 2008; 103: 1039-1047
        • Interian A.
        • Allen L.A.
        • Gara M.A.
        • Escobar J.I.
        • Diaz-Martinez A.M.
        Somatic complaints in primary care: Further examining the validity of the Patient Health Questionnaire (PHQ-15).
        Psychosomatics. 2006; 47: 392-398
        • Knisely J.S.
        • Wunsch M.J.
        • Cropsey K.L.
        • Campbell E.D.
        Prescription Opioid Misuse Index: A brief questionnaire to assess misuse.
        J Subst Abuse Treat. 2008; 35: 380-386
        • Kroenke K.
        • Spitzer R.L.
        • Williams J.B.
        The PHQ-9: Validity of a brief depression severity measure.
        J Gen Intern Med. 2001; 16: 606-613
        • Kroenke K.
        • Spitzer R.L.
        • Williams J.B.
        • Lowe B.
        The Patient Health Questionnaire Somatic, Anxiety, and Depressive Symptom Scales: A systematic review.
        Gen Hosp Psychiatry. 2010; 32: 345-359
        • Kuo Y.F.
        • Raji M.A.
        • Chen N.W.
        • Hasan H.
        • Goodwin J.S.
        Trends in opioid prescriptions among Part D Medicare recipients from 2007 to 2012.
        Am J Med. 2016; 129: 221.e21-221.e30
        • Lowe B.
        • Decker O.
        • Muller S.
        • Brahler E.
        • Schellberg D.
        • Herzog W.
        • Herzberg P.Y.
        Validation and standardization of the Generalized Anxiety Disorder Screener (GAD-7) in the general population.
        Med Care. 2008; 46: 266-274
        • Mack K.A.
        • Zhang K.
        • Paulozzi L.
        • Jones C.
        Prescription practices involving opioid analgesics among Americans with Medicaid, 2010.
        J Health Care Poor Underserved. 2015; 26: 182-198
        • Martins S.S.
        • Sampson L.
        • Cerda M.
        • Galea S.
        Worldwide prevalence and trends in unintentional drug overdose: A systematic review of the literature.
        Am J Public Health. 2015; 105: e29-e49
        • McHugh R.K.
        • Fitzmaurice G.M.
        • Carroll K.M.
        • Griffin M.L.
        • Hill K.P.
        • Wasan A.D.
        • Weiss R.D.
        Assessing craving and its relationship to subsequent prescription opioid use among treatment-seeking prescription opioid dependent patients.
        Drug Alcohol Depend. 2014; 145: 121-126
        • Murphy J.L.
        • Clark M.E.
        • Banou E.
        Opioid cessation and multidimensional outcomes after interdisciplinary chronic pain treatment.
        Clin J Pain. 2013; 29: 109-117
        • Nelson L.S.
        • Juurlink D.N.
        • Perrone J.
        Addressing the opioid epidemic.
        JAMA. 2015; 314: 1453-1454
        • Nicholas M.K.
        The pain self-efficacy questionnaire: Taking pain into account.
        Eur J Pain. 2007; 11: 153-163
        • Rome J.D.
        • Townsend C.O.
        • Bruce B.K.
        • Sletten C.D.
        • Luedtke C.A.
        • Hodgson J.E.
        Chronic noncancer pain rehabilitation with opioid withdrawal: Comparison of treatment outcomes based on opioid use status at admission.
        Mayo Clin Proc. 2004; 79: 759-768
        • Scott W.
        • McCracken L.M.
        Patients’ impression of change following treatment for chronic pain: Global, specific, a single dimension, or many?.
        J Pain. 2015; 16: 518-526
        • Sheehan D.V.
        • Lecrubier Y.
        • Sheehan K.H.
        • Amorim P.
        • Janavs J.
        • Weiller E.
        • Hergueta T.
        • Baker R.
        • Dunbar G.C.
        The Mini-International Neuropsychiatric Interview (M.I.N.I.): The development and validation of a structured diagnostic psychiatric interview for DSM-IV and ICD-10.
        J Clin Psychiatry. 1998; 59 (quiz: 34-57): 22-33
      2. Substance Abuse and Mental Health Services Administration: Results from the 2013 National Survey on Drug Use and Health: Summary of National Findings. Available at: Accessed April 26, 2016

        • Tan G.
        • Jensen M.P.
        • Thornby J.I.
        • Shanti B.F.
        Validation of the Brief Pain Inventory for chronic nonmalignant pain.
        J Pain. 2004; 5: 133-137
        • Townsend C.O.
        • Kerkvliet J.L.
        • Bruce B.K.
        • Rome J.D.
        • Hooten W.M.
        • Luedtke C.A.
        • Hodgson J.E.
        A longitudinal study of the efficacy of a comprehensive pain rehabilitation program with opioid withdrawal: Comparison of treatment outcomes based on opioid use status at admission.
        Pain. 2008; 140: 177-189
        • Turner J.A.
        • Anderson M.L.
        • Balderson B.H.
        • Cook A.J.
        • Sherman K.J.
        • Cherkin D.C.
        Mindfulness-based stress reduction and cognitive-behavioral therapy for chronic low back pain: Similar effects on mindfulness, catastrophizing, self-efficacy, and acceptance in a randomized controlled trial.
        Pain. 2016; 157: 2434-2444
        • Weiss R.D.
        • Potter J.S.
        • Fiellin D.A.
        • Byrne M.
        • Connery H.S.
        • Dickinson W.
        • Gardin J.
        • Griffin M.L.
        • Gourevitch M.N.
        • Haller D.L.
        • Hasson A.L.
        • Huang Z.
        • Jacobs P.
        • Kosinski A.S.
        • Lindblad R.
        • McCance-Katz E.F.
        • Provost S.E.
        • Selzer J.
        • Somoza E.C.
        • Sonne S.C.
        • Ling W.
        Adjunctive counseling during brief and extended buprenorphine-naloxone treatment for prescription opioid dependence: A 2-phase randomized controlled trial.
        Arch Gen Psychiatry. 2011; 68: 1238-1246
        • Windmill J.
        • Fisher E.
        • Eccleston C.
        • Derry S.
        • Stannard C.
        • Knaggs R.
        • Moore R.A.
        Interventions for the reduction of prescribed opioid use in chronic non-cancer pain.
        Cochrane Database Syst Rev. 2013; : CD010323