Opioid tapering may improve outcomes for chronic pain patients

 For the roughly 10 million U.S. adults with chronic pain prescribed long-term opioid therapy, tapering the opioid dose over time can lead to improvements in pain, function and quality of life, according to results of a literature review online today in Annals of Internal Medicine.

The study team reviewed 67 relevant studies (11 randomized controlled and 56 observational studies) to gauge the effectiveness of strategies to reduce or stop long-term opioid therapy prescribed for chronic pain and the impact on patient outcomes. These strategies included interdisciplinary pain programs, buprenorphine-assisted opioid tapering and behavioral interventions.

Study quality was judged to be good or fair for 16 studies and poor for 51 studies. While the overall quality of the evidence was “very low,” fair-quality studies showed that opioid dose reduction was associated with improvements for outcomes such as pain, function, and quality of life, the authors note.

An increasing portion of a hospitalist's caseload includes patients with opioid use disorder, patients admitted for opioid overdose or long-term therapy, and those requiring new opioid prescriptions on discharge, Dr. Pooja Lagisetty and Dr. Amy Bohnert, IHPI members from U-M, point out.

They acknowledge that inpatient initiation of opioid-agonist therapy (OAT) “may seem out of the scope of hospitalist practice. Interestingly, this sentiment mirrors that of an earlier era when hospitalists first started treating alcohol withdrawal on inpatient wards. This reluctance was overcome with physician education. A similar paradigm could apply to the growing opioid crisis. Hospitalists must become educated on monitoring withdrawal, initiating OAT, and identifying outpatient providers to continue treatment,” Drs. Lagisetty and Bohnert recommend.

“Hospitalists can no longer be bystanders to the sea change in opioid treatment practices. Just as they have always done, hospitalists must embrace this challenge and lead change in health care delivery during this growing epidemic,” they conclude.