Reducing prescribed opioid use in adults with chronic non-cancer pain


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Bottom line

Based on the available evidence, we do not know the best method of reducing opioids in adults with chronic pain conditions. We found mixed results from a small number of studies included in this review.

Background

This is an updated review. The first review was published in 2013. About one in five adults suffer from moderate or severe chronic pain that is not caused by cancer. Some people with this type of pain are treated with opioids (typically with drugs such as morphine, codeine, oxycodone, fentanyl, or buprenorphine, either as tablets or as patches placed on the skin). It is not unusual for this medication to be ineffective or to stop working over time, and, sometimes, effective pain relief is not achieved despite doses being increased. Stopping using opioid drugs is not easy, especially when they have been used for some time, because stopping abruptly can cause unpleasant side effects.This review looked for high-quality studies (randomised controlled trials) of treatments to help adults safely stop taking opioids prescribed for their pain.

Study characteristics

We searched for studies up to January 2017. We found five studies, and they investigated 278 people. Most people included in the studies were women, who were around 50 years of age, and reported a mixture of chronic pain conditions (e.g. headache, back pain, muscle pain). The studies included acupuncture, mindfulness, and cognitive behavioral therapy as strategies to decrease the amount of opioids taken by adults with chronic pain.

Key results

No conclusions can be drawn from this small amount of information. Therefore, it is not clear whether these treatments decrease the amount of opioids in adults with chronic pain (primary outcome) or reduce pain intensity, physical ability or mood (secondary outcomes). Three studies did include negative effects of their treatment, and two reported that the participants did not have anything negative happen to them because of the trial they were in. Non-randomised studies, not included in this review, do indicate that for many people intensive rehabilitation packages may bring about major reduction in opioid use. Reducing prescribed opioid use in chronic non-cancer pain is an important topic in need of more systematic research.

Quality of the evidence

We were not able to judge the quality of evidence included in this review because the studies were so different and could not be combined.