[To taper or not to taper opioids - that is the question]
Emmanuel Bäckryd1, Paulin Andréll2, Marcelo Rivano Fischer3
1bitr -professor, över-läkare, Linköpings -universitet.
Lakartidningen
|August 20, 2025
Summary
Long-term opioid treatment for chronic non-cancer pain lacks evidence and European guidelines advise against it. Continuous assessment and early discontinuation are crucial to prevent adverse outcomes, with careful tapering considered.
Area of Science:
- Pain Management
- Pharmacology
- Public Health
Background:
- Limited evidence supports long-term opioid therapy for chronic non-cancer pain.
- European guidelines recommend against using opioids for primary chronic pain conditions.
- Continuous evaluation of opioid benefits and harms is essential.
Purpose of the Study:
- To highlight the complexities of long-term opioid treatment for chronic non-cancer pain.
- To emphasize the importance of considering opioid tapering (deprescribing).
- To outline potential benefits and risks associated with opioid tapering.
Main Methods:
- Review of current guidelines and clinical considerations for long-term opioid use.
- Discussion of the tapering process, including planned support and follow-up.
- Analysis of potential benefits (safety, side effect reversal) and risks (withdrawal, mental health).
Main Results:
- Opioid tapering is a complex medical intervention with potential benefits and risks.
- Risks of tapering include withdrawal symptoms, pain exacerbation, and mental health issues.
- Problematic opioid use and opioid use disorder are concerns in this patient population.
Conclusions:
- Opioid tapering requires careful planning, support, and close monitoring.
- Prescribers should avoid stigmatizing attitudes towards patients with problematic opioid use.
- Early discontinuation of opioids should be considered to prevent negative health trajectories.
Related Concept Videos
01:15Opioid Analgesics: Synthetic and Semisynthetic Opioids
426
Synthetic and semisynthetic opioids are pivotal in pain management and tackling opioid addiction. Semisynthetic opioids, including morphinans (morphine derivatives), oxycodone, oxymorphone, hydrocodone, and hydromorphone, have improved pharmacokinetic profiles compared to morphine. Additionally, heroin and 6-MAM (6-Monoacetylmorphine) show better CNS penetration than morphine due to heightened lipid solubility. Hydromorphone, a potent opioid, undergoes hepatic metabolism to form the active...
426
01:20Opioid Analgesics: Morphine and Other Natural Cogeners
361
Opioids are a class of drugs that mimic endogenous opioid peptides and act on opioid receptors, and help in pain relief. These compounds are classified as natural, synthetic, or semi-synthetic. Natural opioids, like morphine, codeine, and thebaine, are derived from the opium poppy plant (Papaver somniferum or Papaver album) and are termed opiates. Synthetic opioids are artificial, while semi-synthetic opioids combine natural and synthetic compounds. Morphine, a prototypical opioid, possesses a...
361
01:25Analgesia and Pain Management
788
Pain is critical to various clinical pathologies, provoking an urgent need for effective management. Pain, whether acute or chronic, is a complex neurochemical process. Its alleviation depends on the type, with nonopioid analgesics effective for mild to moderate pain, such as musculoskeletal or inflammatory pain, while neuropathic pain responds best to anticonvulsants, tricyclic antidepressants, or serotonin/norepinephrine reuptake inhibitors. For severe acute or chronic pain, opioids may be...
788
01:20Desensitization and Tachyphylaxis
2.2K
Tachyphylaxis is described as a rapid decrease in response to a drug after repeated or continuous administration of the same drug dose. It is a phenomenon where the body becomes less responsive to a particular substance or intervention over time, requiring higher doses or stronger interventions to achieve the same effect. It results from adaptive changes in the body's receptors, signaling pathways, or physiological processes that occur in response to prolonged exposure to a stimulus.
2.2K
01:22Opioid Receptors: Overview
1.8K
Opioid receptors, including the mu (μ, MOR), delta (δ, DOR), and kappa (κ, KOR) types, belong to the rhodopsin family of G protein-coupled receptors. These receptors are located throughout the central and peripheral nervous systems and in non-neuronal tissues such as macrophages and astrocytes. Opioid receptor ligands can be categorized into agonists or antagonists. Highly selective agonists include [d-Ala2, MePhe4, Gly(ol)5]-enkephalin or DAMGO for MOR, [D-Pen2,...
1.8K
01:17Drugs Affecting GI Tract Motility: Opioids as Antidiarrheal Agents
326
Diarrhea, a condition marked by frequent loose or watery bowel movements, can be triggered by multiple factors such as viral or bacterial infections, food intolerances, anxiety, medications, and digestive disorders. Symptoms may include abdominal pain, bloating, nausea, and cramping. Severe or prolonged diarrhea can lead to complications like electrolyte imbalances, malnutrition, and dehydration if left untreated.
Opioids, widely used antidiarrheal agents, mitigate diarrhea by slowing down...
Opioids, widely used antidiarrheal agents, mitigate diarrhea by slowing down...
326