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Updated: Jul 8, 2026

Determining Pain Detection and Tolerance Thresholds Using an Integrated, Multi-Modal Pain Task Battery
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Patient-Centered Prescription Opioid Tapering Methods : A Randomized Clinical Trial.

Beth D Darnall1, Luzmercy Perez2, Ming-Chih Kao3

  • 1Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, and Stanford Pain Relief Innovations Lab, Palo Alto, California (B.D.D.).

Annals of Internal Medicine
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PubMed
Summary
This summary is machine-generated.

Adding cognitive behavioral therapy or self-management programs to opioid tapering did not improve success rates. However, cognitive behavioral therapy may help reduce adverse effects during the tapering process.

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Area of Science:

  • Pain Management
  • Clinical Trials
  • Public Health

Background:

  • Long-term prescription opioid use requires evidence-based tapering strategies in outpatient settings.
  • Chronic pain management often involves long-term opioid therapy, necessitating safe and effective discontinuation plans.

Purpose of the Study:

  • To compare the effectiveness of three opioid tapering strategies for chronic pain patients.
  • To evaluate patient-centered tapering alone versus combined with cognitive behavioral therapy for chronic pain (pain-CBT) or a chronic pain self-management program (CPSMP).

Main Methods:

  • A randomized controlled trial involving 562 adult participants receiving high-dose opioids for chronic pain.
  • Participants were assigned to: taper only, taper plus pain-CBT, or taper plus CPSMP.
  • Taper success was defined as a 50% reduction in morphine equivalent daily dose (MEDD) with no pain increase, or no MEDD increase with decreased pain intensity.

Main Results:

  • The taper success rates were 50.9% (taper only), 48.6% (taper plus pain-CBT), and 44.5% (taper plus CPSMP), with no significant differences between groups.
  • Adding pain-CBT or CPSMP did not improve taper success compared to tapering alone.
  • The risk of study-related adverse events, including opioid withdrawal symptoms, was highest in the taper-only group.

Conclusions:

  • Patient-centered opioid tapering combined with pain-CBT or CPSMP did not enhance taper success rates at 12 months.
  • Cognitive behavioral therapy (CBT) may potentially reduce adverse effects, such as opioid withdrawal symptoms, during tapering.
  • Further research is needed to optimize opioid tapering protocols and manage adverse events effectively.