Patient-Centered Opioid Tapering for Chronic Pain
Key Takeaways
- Taper success at 12 months was similar with taper only, taper plus pain-CBT, and taper plus CPSMP.
- Taper success reflected either a substantial MEDD reduction without more pain or no MEDD increase with lower pain intensity.
- Study-related adverse events, including opioid withdrawal symptoms, were reported most often with taper only.
The randomized controlled trial was conducted at 11 U.S. sites. Eligible participants were adults with pain for at least 6 months who had received a morphine equivalent daily dose of 10 or higher for at least 3 months. Participants did not have moderate or severe opioid use disorder. Patient-centered tapering included close monitoring and electronic supports.
Taper success was defined as at least a 50% MEDD decrease without increased pain, or no MEDD increase with decreased pain intensity. Researchers randomized 191 participants to taper only, 203 to pain-CBT, and 168 to CPSMP. At 12 months, taper success occurred in 50.9%, 48.6%, and 44.5% of the three groups, respectively. Compared with taper only, differences were -2.4 percentage points for pain-CBT and -5.2 percentage points for CPSMP, with 95% CIs of -11.9 to 7.2 and -15.3 to 4.8.
Study-related adverse events were most common in the taper-only group, and that category included opioid withdrawal symptoms. These events occurred in 126 of 191 participants, or 66%, with taper only, 109 of 203, or 54%, with pain-CBT, and 108 of 168, or 64%, with CPSMP.
The authors concluded that adding CBT or self-management to patient-centered tapering did not improve taper success at 12 months, although CBT may reduce adverse effects, including opioid withdrawal symptoms. They noted that COVID-19-related challenges reduced sample size and created imbalance between treatment groups.