Patients receiving long-term
opioid therapy for
chronic pain and interested in tapering their
opioid dose were randomly assigned to a 22-week taper support intervention (psychiatric consultation,
opioid dose tapering, and 18 weekly meetings with a physician assistant to explore motivation for tapering and learn
pain self-management skills) or usual care (N = 35). Assessments were conducted at baseline and 22 and 34 weeks after randomization. Using an intention to treat approach, we constructed linear regression models to compare groups at each follow-up. At 22 weeks, adjusted mean daily
morphine-equivalent
opioid dose in the past week (primary outcome) was lower in the taper support group, but this difference was not statistically significant (adjusted mean difference = -42.9 mg; 95% confidence interval, -92.42 to 6.62; P = .09).
Pain severity ratings (0-10 numeric rating scale) decreased in both groups at 22 weeks, with no significant difference between groups (adjusted mean difference = -.68; 95% confidence interval, -2.01 to .64; P = .30). The taper support group improved significantly more than the usual care group in self-reported
pain interference,
pain self-efficacy, and prescription
opioid problems at 22 weeks (all P-values < .05). This taper support intervention is feasible and shows promise in reducing
opioid dose while not increasing
pain severity or interference.
PERSPECTIVE: In a pilot randomized trial comparing a prescription
opioid taper support intervention to usual care, lower
opioid doses and
pain severity ratings were observed at 22 weeks in both groups. The groups did not differ significantly at 22 weeks in
opioid dose or
pain severity, but the taper support group improved significantly more in
pain interference,
pain self-efficacy, and perceived
opioid problems. These results support the feasibility and promise of this
opioid taper support intervention.