Chronic pain remains a complex challenge, difficult to treat effectively. The prescription of opioids for managing this condition has sparked controversy but can be beneficial for some patients. With an aim to guide clinician practices, a new study delves into the pros and cons of maintaining or discontinuing long-term opioid use in adults dealing with chronic pain, which is prevalent worldwide.
The researchers gathered insights from 28 experts on the balance between continuing, tapering off, or stopping opioid medications for non-cancer related chronic pain. The findings revealed a lack of consensus among these specialists regarding the best course of action.
Only slightly more than one-third (36%) of the surveyed experts believed that long-term opioid therapy offers advantages to patients with chronic pain lasting three months or longer, while an equal percentage advocated for discontinuing this treatment. Over half expressed concerns about potential harm from abrupt reduction and withdrawal from opioids, suggesting a cautious approach in tapering down usage.
Several recommendations were made by the experts. Some recommended trying a slow and methodical tapering process even if initial attempts have been unsuccessful, possibly alongside other medications to ease withdrawal symptoms. There was also support for transitioning patients to buprenorphine, which mitigates physical dependence associated with opioids such as withdrawal symptoms and cravings.
Additional suggestions included incorporating non-opioid pain management techniques, regardless of past ineffective trials, and engaging in shared decision-making processes between physicians and their patients. However, there was minimal agreement on how to implement these strategies effectively.
A few experts also highlighted the importance of addressing co-occurring conditions that could affect patient safety, such as alcohol misuse or mental health issues related to opioid use. Unfortunately, only a small number discussed assessing for opioid use disorder or overdose risk among patients.
The known risks associated with long-term opioid use include physical dependency and potential side effects like addiction, withdrawal symptoms upon discontinuation, increased pain intensity, mental health complications such as depression or anxiety, and social issues due to reduced mobility. The fear of these consequences can lead patients to resist being weaned off opioids.
On the positive side, these medications provide significant relief from severe chronic pain that impairs daily functioning in areas like family interactions, employment, and participation in social activities.
“We need guidelines for continuing or tapering opioid prescriptions for long-term use,” says Dr. Kurt Kroenke of Regenstrief Institute and Indiana University School of Medicine. “However, these can be difficult to implement due to liability concerns, changing regulations within the healthcare system, diverse views on the benefits versus risks from both providers and patients, as well as some practitioners’ belief that opioid dependence clouds a patient’s judgment.” According to Dr. Kroenke, decisions regarding long-term opioid management should be made with consideration of informed consent and respectful dialogue between doctors and their patients.
The study “Management of Patients at Risk for Harms from Both Continuing and Discontinuing Their Long-Term Opioid Therapy: A Qualitative Study to Inform the Gap in Clinical Practice Guidelines” has been published in Pain Practice, a peer-reviewed journal.
