Discontinuing Opioid Therapy Could Improve Chronic Pain

Discontinuation of long-term opioid therapy (LTOT) was associated with sustained or decreased levels of chronic, non-cancer pain, according to the results of a recent study.

In order to characterize pain intensity following opioid discontinuation, researchers conducted a retrospective VA administrative data study involving 551 patients with chronic pain. Data was collected for the 12 months leading up to and 12 months following discontinuation. Of the 551 participants, 87% had chronic musculoskeletal pain, 6% had neuropathic pain, and 11% had headache-related pain. The mean estimated pain at time of opioid discontinuation was 4.9.

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Random effects regression analyses were used to examine changes in 0-10 pain rating scale scores, while growth mixture models delineated pain trajectory subgroups.

Overall, the changes in pain intensity included slight but statistically non-significant declines in pain intensity following discontinuation of LTOT. Four pain trajectory classes were characterized: no pain, mild clinically-significant pain, moderate clinically-significant pain, and severe clinically-significant pain. Pain trajectories in each of these 4 classes were also characterized by slight reductions over time, with those in the mild and moderate groups experiencing the greatest reductions following discontinuation of LTOT.

“Pain intensity following discontinuation of LTOT does not, on average, worsen for patients and may slightly improve, particularly for patients with mild-to-moderate pain at the time of discontinuation. Clinicians should consider these findings when discussing risks of opioid therapy and potential benefits of opioid taper with patients.”

—Michael Potts

Reference:

Changes ii pain intensity following discontinuation of long-term opioid therapy for chronic non-cancer pain [published online June 13, 2018]. Pain. doi: 10.1097/j.pain.0000000000001315.