Interventions to reduce long-term opioid therapy in patients with chronic pain show some benefits, according to a review in the Annals of Internal Medicine, but the overall quality of the evidence is low.
Researchers examined data from 11 randomized trials and 56 observational studies that assessed strategies to decrease or discontinue long-term opioid therapy in adults with chronic pain. Strategies included interdisciplinary pain programs, buprenorphine-assisted dose reduction, behavioral interventions, and detoxification, among others.
Rates of opioid discontinuation varied across the studies, with very-low-quality evidence. In terms of patient outcomes after dose reduction, fair quality studies — mostly of interdisciplinary programs — suggested benefits in pain severity, function, and quality of life.
Editorialists write, “Although it will be important to confirm the results with more and higher-quality studies, this review provides evidence that patients who work with clinicians to reduce or discontinue opioid use can expect improvements in pain, function, and quality of life. Clinicians should find comfort in being able to communicate this hope to patients.”