Does Opioid Tapering in Chronic Pain Result in Controlled Pain at Taper Completion?

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Opioid tapering may result in an alleviation of chronic pain, but this notion is based on low-level evidence.

Opioid tapering may result in an alleviation of chronic pain, but this notion is based on low-level evidence, according to a systematic review published in Pain Medicine.

For this systematic review, a total of 20 studies — published in Embase, Medline, Psychological Abstracts, PsycINFO, CINAHL, Science Citation Index, or the National Library of Medicine Physician Data Query database — in which the effects of opioid tapering were examined in alleviating pain in patients with chronic pain (n=2109) were examined. All studies had a type 3 or 4 level of evidence (ie, studies were not controlled) and reported pain levels before and after taper.

In 80% of the studies, opioid tapering resulted in improvement in pain, with 81.2% of these studies reporting statistically significant results. In 15% of studies examined, no changes in pain were reported between pretapering and posttapering of opioids. In one study, 97% of participants reported improvement or unchanged level of pain after tapering, and the remaining 3% had worse pain at the end of the tapering period. This result had an A consistency rating according to the Agency for Health Care Policy and Research Levels of Evidence Guidelines.

Limitations of the systematic review are linked with the studies examined, which had low level of evidence, lacked control participants, and were retrospective in nature (45%).

“The results of this systematic review support the clinical observation that opioid tapering in some [patients with chronic pain] does not necessarily increase pain. However, as the reviewed studies were type 3 and 4 (low level of evidence) and the focus of this review was not their primary question, further research is required to answer this question in a definitive manner. These studies should be prospective, type 2 studies specifically designed to address the hypothesis of this systematic review,” concluded the review authors.

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Fishbain DA, Pulikal A. Does opioid tapering in chronic pain patients result in improved pain or same pain vs increased pain at taper completion? A structured evidence-based systematic review [published online December 28, 2018]. Pain Med. doi: 10.1093/pm/pny231