Background & Aims

Opioids are commonly prescribed for the management of chronic non-cancer pain. However, current evidence does not support their long-term use and people taking opioids may need support to reduce or stop their use.
The research aimed to inform better practice, pathways and service design to support people with chronic non-cancer pain to reduce or stop their opioid use and to address inequalities in access.
Specifically, the systematic literature review for the effectiveness of tapering interventions aimed to evaluate the published evidence on effectiveness, safety (including adverse effects) and acceptability of interventions to reduce or discontinue opioid use.

Methods

We undertook four systematic literature reviews of interventions aiming to reduce or discontinue opioid use: (i) effectiveness; (ii) safety and acceptability; (iii) barriers and facilitators and (iv) inequalities. Searches included databases (MEDLINE, Embase, CENTRAL, PsycINFO), trial registries (EU-CTR, ISRCTN, ANZCTR, Clinical trials.gov), websites (NIHR-be part of research, NICE Evidence Search, HMIC, British Pain Society Members area) and repositories (Google Scholar, CORE.ac.uk) up to September 2022.
Records were independently screened by two reviewers for inclusion using prespecified criteria including: (i) adults with chronic non-cancer pain, with (ii) prescription opioid use ?3 months, (iii) intervention aiming to reduce or discontinue opioid use. Eligible studies were quality assessed and predefined data were extracted.
Data were synthesised and presented using tables and narrative synthesis. Meta-analysis was not appropriate.

Results

Twenty-seven studies (11 comparative studies and 16 non-comparative studies) were identified. Study characteristics, interventions used, intervention function and reported outcomes were heterogeneous between studies. Interventions included pain management programmes (PMP), tapering guidelines, pharmacological-assisted opioid tapering, tapering only, acupuncture, psychological approaches and clinical encounters.
Fifteen studies reported pain outcomes. In 7/8 comparative studies, pain severity did not differ between intervention and control groups. 22/27 studies reported change in opioid use and 26/27 studies reported cessation. Results favoured PMP and pharmacological-assisted opioid tapering; results were mixed for guidelines and acupuncture and were modest for psychological approaches. Other outcomes included anxiety, depression, sleep quality and intervention acceptability. Five studies reported adverse events (AE). There were no serious AEs and no participants withdrew due to AEs.

Conclusions

This research describes a range of tapering interventions and their effectiveness. Evidence to support any specific opioid tapering intervention was of low quality and effectiveness results were mixed and uncertain.
Further research to identify the most effective method(s) to reduce or discontinue opioid use should be a priority. Data is needed from long-term randomised controlled trials (RCTs) that compare the effectiveness of tapering interventions using core outcome sets and including patients with similar baseline characteristics, such as opioid used and opioid dose, duration of opioid use, type of pain and pain severity. Cessation of opioid use is a clinically important outcome, however, defining a clinically meaningful reduction in opioid use and pain severity is problematic. Long-term follow-up data is required to show whether reduced opioid use is sustained. RCTs should also assess patient acceptability.

References

1.Roger Chou, Judith A. Turner, Emily B. Devine, et al. The Effectiveness and Risks of Long-Term Opioid Therapy for Chronic Pain: A Systematic Review for a National Institutes of Health Pathways to Prevention Workshop. Ann Intern Med.2015;162:276-286. [Epub 17 February 2015]. doi:10.7326/M14-2559

Presenting Author

Rebecca Bresnahan

Poster Authors

Rebecca Bresnahan

PhD

University of Liverpool

Lead Author

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Ruaraidh Hill PhD

University of Liverpool

Lead Author

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Michelle Maden PhD

University of Liverpool

Lead Author

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Rui Duarte

Lead Author

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Sam Eldabe

The James Cook University Hospital, Middlesbrough, UK

Lead Author

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Su Golder

Lead Author

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Marty Chaplin

Lead Author

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Beth Shaw

Lead Author

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Katy Sutcliffe

Lead Author

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Adam Todd

Lead Author

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Katherine Edwards

Lead Author

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Janette Greenhalgh

Lead Author

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Juliet Hounsome

Lead Author

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Jack Trafford

Lead Author

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Nefyn Williams

Lead Author

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Topics

  • Systematic Reviews/Meta-Analysis