How Does Tapering Opioids Affect Pain Levels?

By Paul Gaita 07/25/17

A new study is examining the impact of reducing opioid treatment in chronic pain patients.

a woman holding one white round pill and glass of water

As health professionals struggle to treat chronic patient pain in a manner that also addresses the opioid dependency epidemic in America, a new study has suggested that lowering doses for patients in long-term opioid treatment may actually improve their pain outcomes.

Though culled from research data that the study authors admittedly described as "very low" in quality, the report did make a case for tapered opioid dosage, in which the patient is slowly weaned off such painkillers, that it might produce improved pain response and quality of life, especially when paired with non-opioid treatments. The study also emphasized the importance of making both non-opioid treatments and addiction treatment more accessible to doctors and chronic pain patients alike.

To conduct their study, published in Annals of Internal Medicine in July 2017, the researchers reviewed 67 studies that examined the impact of reducing opioid treatment in more than 12,000 patients with chronic pain. Independent reviewers extracted the pertinent data and assessed the quality of each study based on the U.S. Preventive Services Task Force rating criteria. More than 50 of the studies were rated as "poor" due to the methodology or sample size employed by the study authors, while an additional 13 were graded as "fair" and just three studies earned "good" ratings. Only data that examined the response from patients who voluntarily tapered their opioid intake was considered.

From that pool of data, which the study authors readily admitted was "very low quality of evidence," research was focused on studies that examined patient outcomes after dose reduction, and found that improvement was reported among patients in regard to pain severity, function and quality of life. The authors noted that several possible factors may have resulted in these outcomes: non-opioid-based pain treatment, such as physical therapy, that may have been employed in addition to dose reductions; the abatement of side effects from long-term opioid use, including depression and sleep disorders, which could negatively impact quality of life; and the possibility that patients were successful in tapering their opioid use "because pain severity decreased."

"We should be cautious in interpreting the findings," said lead author Joseph Frank, who stressed that more research was crucial to determining the exact result of tapered opioid usage. "I want patients and doctors to use caution in applying this [study's findings]." Addiction researcher Stefan Kertesz of the University of Alabama Birmingham also notes that, like opioid use itself, tapering their use is best considered on a case-by-case basis. "There are people who do well with tapering opioids," said Kertesz. "[And] there are people who do not do well with [it]."

Ultimately, the most significant finding of the report is the need for non-opioid strategies and supplemental care as a key component of reduction. Though many chronic pain patients appear to prefer alternatives—which can range from over-the-counter pain relievers like ibuprofen to psychological options like mindfulness practice to marijuana—they may lack insurance coverage or access to a clinic or doctor who can prescribe such treatments. Addiction treatment should also be expanded to care for opioid patients, who may turn to harder and more lethal drugs like heroin or fentanyl to avoid withdrawal.

A number of studies have shown that these untreated patients are a major component in the current opioid dependency epidemic. "It's an important part of this challenge," said Joseph Frank. "These non-opioid strategies that were tested in these research studies are not adequately available. Several of the studies were done in pain centers where they have expert programs, and those just are not widespread."

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Paul Gaita lives in Los Angeles. He has contributed to the Los Angeles Times, Variety, LA Weekly, and The Los Angeles Beat, among many other publications and websites.