A systematic review in the Annals of Internal Medicine has reviewed 67 studies covering eight different intervention categories for chronic pain. These categories included interdisciplinary pain programs, buprenorphine assisted dose reduction, and behavioral interventions.
The study found that after dose reduction in chronic opiate therapy, there was overall improvement in reported pain severity, improvement in function, and improvement in quality of life.
CNN also discussed this article. In their research, several thought leaders in the area of pain management and opiate therapy were interviewed. In this article, both the benefits and challenges of dose reduction of chronic opiates were reviewed. Some of the more interesting quotes included the following. The CDC’s Tamara Haegerich said,
"This study provides needed information for providers about how to taper and/or discontinue opioids safely and effectively -- that is, with nonopioid treatments, slow reductions in opioid dosage, patient buy-in, and close monitoring,"
Regarding the difficulty of reducing or discontinuing chronic opiates, Dr. Andrew Kolodny, co-director of opioid policy research at the Heller School for Social Policy and Management, said,
“"It's not just they are experiencing excruciating pain. Panic sets in; it's a psychological response. It's been described as a sense of impending doom…Getting patients off is not easy. The patients that were able to get off needed lots of visits and multidisciplinary care.”
Dr. Steven Stanos, president of the American Academy of Pain Medicine also acknowledged the difficulty of decreasing and discontinuing chronic opiate there. Dr. Stanos said,
"You need to have the resources to do this. Articles like this show we need to have greater access to behavioral health, interdisciplinary programs.”
Unfortunately, many patients do not have access to multidisciplinary therapies and strong support teams.
While reduction or elimination of chronic opiates is a goal that many physicians are striving for, access to effective non-opiate treatments remains a challenge.