21 Jan Does opioid reduction in Chronic Pain Patients (CPP) result in improved pain?
“Does opioid tapering on Chronic Pain Patients (CPP) result in improved pain or the same pain vs. increased pain at taper completion? A structured evidenced based – systemic review”
Citation: D. Fishbain MD FAPA, Aditya Pulikal MD, JD Pain Medicine Dec, 2018
A recent systemic review of the available literature examined the impact on the tapering / removal of chronic opioid use by chronic pain patients (cpp) and the resulting impact on chronic pain patients (CPPs) pain. The findings were as follows:
Combining all studies, 2,109 CPPs were tapered. Eighty percent of the studies reported that by taper completion pain had improved. Of these, 81.25% demonstrated this statistically. In 15% of the studies, pain was the same by taper completion. One study reported that by taper completion, 97% of the CPPs had improved or the same pain, but CPPs had worse pain in 3%. As such, 100% of the studies supported the hypothesis. Applying the Agency for Health Care Policy and Research Levels of Evidence Guidelines to this result produced an “A” consistency rating.
There is consistent type 3 and 4 study evidence that opioid tapering in CPPs reduces pain or maintains the same level of pain. However, these studies represented lower levels of evidence and were not designed to test the hypothesis, with the evidence being marginal in quality with large amounts of missing data. These results then primarily reveal the need for controlled studies (type 2) to address this hypothesis.
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