Ceasing use

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An Australian study of 10,000 patients has found opioid cessation led to reduced pain and improved function in people attending chronic pain services

Researchers from the Australian Health Services Research Institute at the University of Wollongong, and Hunter New England Health in Newcastle, NSW, analysed data collected at 67 specialist pain services between January 2015 – June 2020.

There were 10,302 patients who provided information about opioid use at both referral and at the end of their treatment episodes, according to their study in the MJA.

Mean age was 49.5 years and a third had experienced their pain for more than five years.

A total of 6340 patients (62%) were using opioid medications at referral, with a mean oral morphine equivalent daily dose of 56.3 mg and a median daily dose of 31 mg.

This group of people reported higher mean pain scores than patients not using opioids at referral, and greater interference in daily activities.

They also had worse mean values for depression, anxiety, stress, pain catastrophising and pain self‐efficacy.

Patients mostly engaged with the pain service through individual appointments with medical and allied health staff (65% of service events) and group pain programs (34%).

By the end of their treatment episodes, 27% patients who reported using opioids at referral had stopped doing so, and 20% of patients had reduced their dose by at least 50%.

Just over half of patients had either not changed their opioid use, or increased or reduced it by less than 50%.

For each group, scores had improved in each clinical domain.

However researchers noticed the changes were greatest for patients who had ceased opioid use, as were the proportions experiencing clinically significant improvement.

Scores for measures specifically related to pain experience, such as pain severity, interference, catastrophising and self‐efficacy, at the end of treatment were similar to or better than those of patients who had not been using opioids at referral, despite greater initial pain severity.

Conversely, the smallest mean improvements were for the patients who had not reduced opioid use by at least 50%.

While the study was limited by its retrospective nature and its restriction to specialist pain practices, the findings are “encouraging”, said authors Hilarie Tardif, Christopher Hayes and Samuel Allingham.

“We found that significant clinical improvements are possible for people with chronic non‐cancer pain attending multidisciplinary pain management services in Australia and New Zealand, even as they discontinue opioid medications,” they said.

See the full research letter here

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