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Research on Stopping Long-Term Opioid Use Opens Up Treatment Alternatives

Putting an end to chronic opioid therapy does not necessarily worsen symptoms, and in some cases, may improve pain

A PPM Brief

Researchers associated with Washington State University have found1 that stopping long-term opioid therapy does not necessarily make chronic, non-cancer-related pain worse and, in some cases, may make it better. The findings may lead to better understanding of how ending long-term opioid use affects patients with different types of chronic pain and how practitioners may better identify effective, non-pharmacological treatments.

The collaboration with Washington State University also involved the Veteran Affairs Portland Health Care System and the Oregon Health & Science University. Survey responses were collected from just over 550 VA patients who had been on long-term opioid therapy for chronic, non-cancer-related pain for at least one year before discontinuing their medication. Patients reported a variety of pain conditions: 87% were diagnosed with chronic musculoskeletal pain, 6% with neuropathic pain, and 11% with headache pain (including migraine).

Survey subjects rated their pain over a period of two years, scoring on a 0 to 10 scale. The researchers used biostatistical analysis and computer modeling to characterize changes in pain intensity 12 months before the patients ended opioid therapy and 12 months after. Changes in pain following discontinuation were characterized by slight but statistically non-significant declines in pain intensity over 12 months post-discontinuation (B = -0.20, p = 0.14). As a whole, survey subject’s pain did not get worse and remained similar or slightly improved, particularly for those with mild-to-moderate pain.

"Our results indicate that long-term opioid therapy does not effectively manage patient pain intensity any more effectively than not receiving long-term opioid therapy," said Sterling McPherson, PhD, associate professor and director for biostatistics and clinical trial design at the WSU Elson F. Floyd College of Medicine. "There are a variety of treatments available for the management of chronic pain other than opioids and our hope is that this research will help promote conversations about these alternatives between doctors and their patients."

The research team plans to collect additional data and conduct qualitative interviews with patients to determine why some patients experience greater reductions in pain than others after discontinuing long-term opioid therapy. “Clinicians should consider these findings when discussing risks of opioid therapy and potential benefits of opioid taper with patients,” the authors concluded in their paper.

Last updated on: August 6, 2018
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