Opioid Weaning May Not Predict Outcomes of Interdisciplinary Program for Chronic Pain

Opioid weaning may not predict long-term outcomes of an interdisciplinary chronic pain rehabilitation program.

Opioid weaning may not predict long-term outcomes of an interdisciplinary chronic pain rehabilitation program (ICPRP), according to a study published in the Journal of Pain.

The study included a total of 1681 participants with treatment-refractory chronic noncancer pain who were treated within an ICPRP. Opioid weaning was included in this ICPRP, which was conducted in an academic medical center between 2007 and 2014. The researchers collected longitudinal follow-up data using self-report paper and pencil questionnaires sent by mail to determine the influence of opioids, mood, patient characteristics, and baseline symptoms on pain and functional improvement in a period ranging from 6 to 12 months after the ICPRP.

Three posttreatment trajectories of pain and functional improvement were identified by latent class growth analysis: mild symptoms and durable benefits, moderate symptoms and durable benefits, and intractable symptoms.

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The results indicated that opioid weaning was not predictive of treatment trajectory. Factors including racial/ethnic minority status, higher levels of posttreatment depression, and lower perceived treatment response were found to be associated with moderate or intractable symptoms. In addition, not having a college education was associated with intractable or worsening pain and a moderate course of functional improvement. Older age and male gender were associated with intractable functional improvement.

“Patients at the greatest risk of posttreatment worsening, or with less symptom resolution, may benefit from continued treatment focused on relapse prevention, or continued less intensive personalized treatment focused on maximizing treatment benefits,” noted the authors.

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Huffman KL, Mandell D, Lehmann JK, Jimenez X, Lapin BR. Clinical and demographic predictors of interdisciplinary chronic pain rehabilitation program treatment response. [published online June 5, 2019]. J Pain. doi:10.1016/j.jpain.2019.05.014