Patients with problematic opioid use can be weaned from codeine without pain escalation

Area of Science:

• Pain Management
• Addiction Medicine
• Cognitive Behavioral Therapy

Background:

• Chronic non-malignant pain patients with problematic opioid use require brief intervention strategies.
• Current treatment gaps exist for managing opioid dependence in this population.

Purpose of the Study:

• To assess the efficacy of brief cognitive-behavioural therapy (CBT) in reducing codeine use.
• To determine if codeine reduction impacts pain levels and quality of life.
• To explore the effects of codeine tapering on neurocognitive functioning.

Main Methods:

• Eleven patients with daily codeine use were treated by physicians using six CBT sessions over 8 weeks.
• Gradual codeine tapering occurred within the 8-week treatment period.
• Assessments included codeine use, pain intensity, quality of life, and neuropsychological functioning from pre-treatment to 3-month follow-up.

Main Results:

• Codeine use significantly decreased from a mean of 237 mg to 45 mg post-treatment and 48 mg at follow-up.
• No significant escalation in pain or reduction in quality of life was observed.
• Neuropsychological functioning showed significant improvements in some areas, with others remaining stable.

Conclusions:

• Brief CBT shows promise for reducing codeine dependence in pain patients with problematic opioid use.
• Further evaluation in larger randomized controlled trials is warranted.
• Comparative studies with alternative brief treatments and placebo conditions are recommended.