Some Pain Patients Can Cut Opioid Dose and Still Get Relief
WEDNESDAY, Feb. 21, 2018 -- Some potentially good news for folks taking opioids for chronic pain: It's possible to slowly reduce the dosage without increasing discomfort, new research suggests.
That's even true for people who've taken the drugs for a long time. One patient in the new study had used opioids for 38 years, the researchers said.
"For some people, long-term opioids are necessary, but it's pretty well known that there has been a high rate of overprescribing of opioids for chronic pain, and there are tremendous health risks for opioids over the long-term," said the study's lead author, Beth Darnall.
"Patients have a lot of fear and concern around opioids. What's been lacking is a way to reduce these drugs on an outpatient basis, and our study found a potentially viable solution," said Darnell, a clinical professor at Stanford University.
That solution? "Partner with patients and let them feel in control, allowing them to pause the tapering of the opioid at any time," she explained.
Prescription opioids -- such as oxycodone (OxyContin and Percocet) -- can be effective pain relievers, but they have a risk of addiction and overdose. From 2000 to 2016, more than 600,000 Americans died from an opioid overdose, according to the U.S. Centers for Disease Control and Prevention. That means about 115 people die because of opioids every day in the United States.
But the new study found that at least some people taking the prescription pain drugs want to get off them, or to at least reduce the amount they take.
The researchers asked people with non-cancer pain who were visiting a pain clinic if they would like to take part in a trial to taper down their opioid use over four months. Eighty-two agreed to take part. Their average age was 52. The researchers excluded anyone with a substance use disorder.
Thirty-one participants dropped out before the trial was completed.
Those who stayed in the study slowly reduced their dose of opioids. At first, they could reduce up to 5 percent of the dose they were taking up to twice in a month. By going this slowly, the researchers said they could minimize withdrawal symptoms and any negative physical or emotional response.
In months two to four, people were allowed to drop their dose by as much as 10 percent per week. Again, it was up to the patients to decide how far down they wanted to go.
"The majority of patients were able to reduce their opioid dose substantially. The goal was not to get to zero, but to help reduce the amount of opioids as much as you comfortably can without increasing pain," Darnall said.
The researchers found that length of time on opioids didn't affect people's success at reducing the drugs. Neither did the dose they took prior to the study.
"This shows that not every patient needs costly inpatient rehab. When patients want to reduce their opioid use, they can reduce it in a low-cost way," Darnall said.
Dr. Kiran Patel, an anesthesiologist and director of neurosurgical pain at Lenox Hill Hospital in New York City, said this study provides "very useful information."
"It's kind of like a few years ago when doctors started discussing opioid-induced constipation with patients. Patients never brought it up, but if you did, they'd say, 'Yeah, that's a problem,' " she said. "So, if you have a conversation about reducing opioids, you may find a willingness in some patients to try to reduce their dose."
Patel noted that the autonomy of this approach was probably helpful. "Pain is often out of their control, so it's important that the patient has control in how much and how frequently their dose goes down," she said.
Being able to reduce opioid dosage will become increasingly important, Patel noted, because insurance companies are starting to refuse to pay for some of these medications.
Both Darnall and Patel said the study needs to be replicated in a larger group of people. And Darnall said they are already planning a larger study.
Results of the study were published as a letter in the Feb. 19 online edition of JAMA Internal Medicine.
Learn more about pain management from the American Society of Anesthesiologists.
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Posted: February 2018