Given America's opioid epidemic, reducing opioid use has become a national priority. But for patients with chronic pain, successfully lowering their long-term dose can prove quite challenging.
A new Stanford study suggests that a voluntary opioid tapering program may be a good strategy for many opioid users with chronic pain. This approach, which allows patients to feel in control, differs from traditional programs with forced, more aggressive dose tapering.
"Slow and steady wins this race. In most cases there is no urgency so we took several months to help patients make the transition comfortably," said first author Beth Darnall, PhD, a Stanford clinical associate professor of anesthesiology, perioperative and pain medicine.
Another key aspect of their tapering program was the cultivation of a trusting patient-physician bond. "Many patients are fearful about reducing opioids. Our study methods focused on providing education to help allay their fears, as well as strengthening that bond to help patients succeed and achieve best outcomes," Darnall explained.
Specifically, the team studied patients with non-cancer chronic pain who were being treated with long-term opioids through a community pain clinic in Colorado. Of the 110 patients invited to participate, 68 volunteered to reduce their opioids and 51 completed the study.
Participating patients were given a self-help book on reducing opioids and an individual plan to slowly taper their dose. They also completed a survey on their demographics, drug use, pain levels and psychosocial measures -- both at the beginning of the study and four months later.
Physicians lowered each patient's dose as much as possible over one year, pausing or stopping as needed, Darnall told me. Many patients reduced their dose by over 50 percent.
Darnall summarized their findings:
We found many patients were interested in joining a voluntary opioid taper program if recommended to them by their doctor. And those who engaged in the opioid taper substantially reduced their opioid dose over four months without experiencing increased pain -- even for those on high-dose opioids who had been taking them for years. Our pilot data suggest that many patients are open to a tapering pathway, if it is presented to them compassionately and in a patient-centered way.
The team is now testing their voluntary tapering program in a large, multi-site study on almost 900 patients taking long-term opioids -- using voluntary tapering alone or combined with behavioral pain treatment.
"We recognize that it's not enough to just reduce patient risks with opioid reduction; we also need to help patients with chronic pain learn the tools to best help themselves," Darnall told me. "We hypothesize that patients will have better opioid and pain reduction when they learn to self-manage their pain and symptoms through one of these two group behavioral treatment classes."
Image of Beth Darnall courtesy of Stanford Pain Medicine
