Patient-Centered Prescription Opioid Tapering Methods : A Randomized Clinical Trial

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.