Prescription Opioid Taper Support for Outpatients With Chronic Pain: A Randomized Controlled Trial

• Published in: The journal of pain Vol. 18; no. 3; pp. 308 - 318
• Main Authors: Sullivan, Mark D, Turner, Judith A, DiLodovico, Cory, D'Appollonio, Angela, Stephens, Kari, Chan, Ya-Fen
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.03.2017
• Subjects: Adult; Aged; Analgesics, Opioid - therapeutic use; Anesthesia & Perioperative Care; Anxiety Disorders - etiology; Chronic opioid therapy; Chronic Pain - drug therapy; Chronic Pain - psychology; Drug Administration Schedule; Female; Follow-Up Studies; Humans; Male; Middle Aged; Opiate Substitution Treatment - methods; opioid dose taper; Opioid-Related Disorders - drug therapy; Opioid-Related Disorders - prevention & control; Opioid-Related Disorders - psychology; Outcome Assessment (Health Care); Outpatients; pain intensity; pain interference; Pain Measurement; Pain Medicine; pain self-management; Pilot Projects; Prescription Drug Misuse - statistics & numerical data; Self Care - methods; Treatment Outcome; pain interference; pain intensity; opioid dose taper; Chronic opioid therapy; pain self-management
• ISSN: 1526-5900; 1528-8447
• DOI: 10.1016/j.jpain.2016.11.003

Abstract Patients receiving long-term opioid therapy for chronic pain and interested in tapering their opioid dose were randomly assigned to a 22-week taper support intervention (psychiatric consultation, opioid dose tapering, and 18 weekly meetings with a physician assistant to explore motivation for tapering and learn pain self-management skills) or usual care (N = 35). Assessments were conducted at baseline and 22 and 34 weeks after randomization. Using an intention to treat approach, we constructed linear regression models to compare groups at each follow-up. At 22 weeks, adjusted mean daily morphine-equivalent opioid dose in the past week (primary outcome) was lower in the taper support group, but this difference was not statistically significant (adjusted mean difference = −42.9 mg; 95% confidence interval, −92.42 to 6.62; P  = .09). Pain severity ratings (0–10 numeric rating scale) decreased in both groups at 22 weeks, with no significant difference between groups (adjusted mean difference = −.68; 95% confidence interval, −2.01 to .64; P  = .30). The taper support group improved significantly more than the usual care group in self-reported pain interference, pain self-efficacy, and prescription opioid problems at 22 weeks (all P -values < .05). This taper support intervention is feasible and shows promise in reducing opioid dose while not increasing pain severity or interference. Perspective In a pilot randomized trial comparing a prescription opioid taper support intervention to usual care, lower opioid doses and pain severity ratings were observed at 22 weeks in both groups. The groups did not differ significantly at 22 weeks in opioid dose or pain severity, but the taper support group improved significantly more in pain interference, pain self-efficacy, and perceived opioid problems. These results support the feasibility and promise of this opioid taper support intervention.