Opioid tapering following the transfer of care of outpatient chronic non-cancer pain patients on high-dose opioid therapy

• Published in: Regional anesthesia and pain medicine Vol. 46; no. 6; pp. 535 - 536
• Main Authors: Chapman, Kenneth B, Pas, Martijn M, Akuamoah, Latrice, Deer, Timothy R, van Helmond, Noud
• Format: Journal Article
• Language: English
• Published: England BMJ Publishing Group Ltd 01.06.2021; BMJ Publishing Group LTD
• Subjects: Analgesics; Authorship; Chronic pain; Interdisciplinary aspects; Morphine; Narcotics; opioid; Pain; pain management; Patients; Regional anesthesia; Research report; Toxicology; United States > US; chronic pain; analgesics; pain management; opioid
• ISSN: 1098-7339; 1532-8651
• DOI: 10.1136/rapm-2020-102191

Guidelines recommend considering tapering in patients treated with opioids for a prolonged period (eg, years) with an unclear benefit-harm balance.2 There is a lack of literature on opioid tapering in routine outpatient settings, because most studies have focused on intensive interdisciplinary tapering programs, that are not typically pursued in the ambulatory environment.3 4 Alternatively, it has been suggested that individualized plans may be used in outpatient settings to achieve taper or maintenance goals.5 The aim of this study is to describe our experience of individualized tapering in patients with CNCP on high-dose opioids in an outpatient pain management setting after transfer of care. Table 1 Demographic and clinical characteristics of all patients, patients who completed 12 months of treatment, and patients who did not complete the 12 months of treatment All Completed treatment Did not complete treatment Sample size, n 91 61 30 Baseline demographics  Age in years, mean±SD 55±11 57±11 54±10  Female/male, n 50/41 36/25 14/16  Employment status, n (%)  Employed 19 (21) 14 (23) 5 (17)  Unemployed 22 (24) 18 (30) 4 (13)  On disability benefits 18 (20) 11 (18) 7 (23)  Retired 23 (25) 16 (26) 7 (23)  Unknown 9 (10) 2 (3) 7 (23)  Insurance type, n (%)  Medicare 32 (35) 23 (38) 9 (30)  Medicaid 6 (7) 2 (3) 4 (13)  Private 42 (46) 29 (48) 13 (43)  Self-pay 3 (3) 1 (2) 2 (7)  Workers compensation 4 (4) 3 (5) 1 (3)  No fault 4 (4) 3 (5) 1 (1) Baseline clinical characteristics  Diagnosis, n (%)  Lower back 72 (79) 47 (77) 25 (83)  Cervical 4 (4) 3 (5) 1 (1)  Arthritis, joint or muscle pain 9 (10) 7 (12) 2 (7)  Other 6 (7) 4 (7) 2 (7)  History of depression, n (%) 24 (26) 22 (36) 2 (7)  MEDD in mg, mean±SD 328±164 330±166 324±164  Duration of opioid therapy >3 years, n (%) 70 (77) 52 (85) 18 (60)  NRS pain intensity, mean±SD 7.3±1.9 7.3±2.0 7.2±1.8 12-month clinical characteristics  Achieved meaningful reduction, n (%) 57 (63) 40 (66) 17 (57)  Reduction in MEDD in mg, mean±SD 179±123 173±110 193±148  Involuntarily discharged due to non-adherence to controlled substance agreement, n (%) 9 (10) 0 (0) 9 (30)  Withdrew from treatment on own initiative, n (%) 21 (23) 0 (0) 21 (70)  Receive opioid therapy from other healthcare providers, n (%) 20 (22) 0 (0) 20 (67)  MEDD opioid therapy received from other healthcare providers in mg, mean±SD 151±30 NA 151±30 MEDD, morphine equivalent daily dose; NRS, numerical rating scale. Table 2 Perceived effect on pain and different areas of daily functioning in patients who achieved a meaningful reduction in daily opioid dosage at 12 months after the transition in care and in patients who did not achieve a meaningful reduction All Meaningful reduction Not meaningful reduction Sample size, n 61 40 21 Pain control, median −1 −1 −1 Daily functioning measures  Overall daily functioning, median 0 0 0  Energy level, median 0 0 0  Sleep, median 0 0 0  Sexual functioning, median 0 0 0  Memory and concentration, median 0 0 0  Anxiety, median 0 0 0  Opioid side effects, median 1 1 0 Vastly worse (−5, −4, −3, −2, −1) unchanged (0) (1, 2, 3, 4, 5) vastly better.