Patient Outcomes Evaluated after Dose Reduction or Discontinuation of Long-Term Opioid Therapy

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SCIENCE
Patient Outcomes Evaluated after Dose Reduction or Discontinuation of Long-Term Opioid Therapy
Key Take-Away: 

Opioids tapering has become challenging for both clinicians and patients in the present scenario. A reduced opioid intake can enhance the quality and functionality of life. The study, therefore, concentrates on finding out effective opioid ceasing strategies.

Expert guidelines recommend reducing or discontinuing long-term opioid therapy (LTOT) when risks outweigh the benefits, but the evidence on the effect of dose reduction on patient outcomes has not been reviewed systematically. 

ABSTRACT: 
Background: 

Expert guidelines recommend reducing or discontinuing long-term opioid therapy (LTOT) when risks outweigh the benefits, but the evidence on the effect of dose reduction on patient outcomes has not been reviewed systematically.

To produce studies of the effectiveness of strategies to reduce or discontinue LTOT and patient outcomes after dose reduction among adults prescribed LTOT for chronic pain, MEDLINE, EMBASE, PsycINFO, CINAHL, and the Cochrane Library from inception through April 2017; reference lists; and expert contacts were analyzed. Original research published in English that addressed dose reduction or discontinuation of LTOT for chronic pain.

Methods: 

Two of the independent reviewers extracted data and assessed the quality of the  study using the U.S. Preventive Services Task Force quality rating criteria.

All authors assessed evidence quality using the GRADE (Grading of Recommendations Assessment, Development, and Evaluation) system. Prespecified patient outcomes were pain severity, function, quality of life, opioid withdrawal symptoms, substance use, and adverse events.

Results: 

Overall sixty-seven studies (11 randomized trials and 56 observational studies) examining eight intervention categories, including interdisciplinary pain programs, buprenorphine-assisted dose reduction, and behavioural interventions, were found.

Study quality was good for three studies, fair for 13 studies, and poor for 51 studies. Many studies reported dose reduction, but rates of opioid discontinuation ranged widely across interventions, and the overall quality of evidence was very low. Among 40 studies examining patient outcomes after dose reduction (very low overall quality of evidence), an improvement was observed in pain severity (8 of 8 fair-quality studies), function (5 of 5 fair-quality studies), and quality of life (3 of 3 fair-quality studies). Heterogeneous interventions and outcome measures; poor-quality studies with uncontrolled designs were some limitations of the study.
 

Conclusion: 

Very low-quality evidence suggested that several types of interventions may be effective to reduce or discontinue LTOT and that pain, function, and quality of life may improve with opioid dose reduction.

 

Source:

Annals of Internal Medicine

Link to the source:

http://annals.org/aim/article/2643842/patient-outcomes-dose-reduction-discontinuation-long-term-opioid-therapy-systematic

The original title of the article:

Patient Outcomes in Dose Reduction or Discontinuation of Long-Term Opioid Therapy: A Systematic Review

Authors:

Joseph W. Frank et al.

Therapeutic, Pain, Chronic, Opioids, Systematic Review, Efficacy
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