Opioid Tapering Results in Improved Pain study concludes

[Cholula]

I found this link in my Doximity feed. I don't have access to the full article but I pasted the abstract here just to share.

David A Fishbain, Aditya Pulikal; Does Opioid Tapering in Chronic Pain Patients Result in Improved Pain or Same Pain vs Increased Pain at Taper Completion? A Structured Evidence-Based Systematic Review, Pain Medicine, , pny231, Does Opioid Tapering in Chronic Pain Patients Result in Improved Pain or Same Pain vs Increased Pain at Taper Completion? A Structured Evidence-Based Systematic Review

Abstract
Objective
To support or refute the hypothesis that opioid tapering in chronic pain patients (CPPs) improves pain or maintains the same pain level by taper completion but does not increase pain.

Methods
Of 364 references, 20 fulfilled inclusion/exclusion criteria. These studies were type 3 and 4 (not controlled) but reported pre/post-taper pain levels. Characteristics of the studies were abstracted into tabular form for numerical analysis. Studies were rated independently by two reviewers for quality. The percentage of studies supporting the above hypothesis was determined.

Results
No studies had a rejection quality score. Combining all studies, 2,109 CPPs were tapered. Eighty percent of the studies reported that by taper completion pain had improved. Of these, 81.25% demonstrated this statistically. In 15% of the studies, pain was the same by taper completion. One study reported that by taper completion, 97% of the CPPs had improved or the same pain, but CPPs had worse pain in 3%. As such, 100% of the studies supported the hypothesis. Applying the Agency for Health Care Policy and Research Levels of Evidence Guidelines to this result produced an A consistency rating.

Conclusions
There is consistent type 3 and 4 study evidence that opioid tapering in CPPs reduces pain or maintains the same level of pain. However, these studies represented lower levels of evidence and were not designed to test the hypothesis, with the evidence being marginal in quality with large amounts of missing data. These results then primarily reveal the need for controlled studies (type 2) to address this hypothesis.

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[Ducttape]

thanks. should move it to the one thread to bind them - The prescription opioid epidemic in a nutshell

fwiw, I notice you wrote "weak evidence".

the conclusions suggest weak evidence for improved or no change pain. it did not suggest worse pain after taper. the implication of your title is a negative one.

 

[Cholula]

Oops, did not mean to imply negative. I'm all for tapering opioids, and will edit title and also reply to to The prescription opioid epidemic in a nutshell thread. I don't know how to delete this thread. Thanks.

 

[thumbz]

I'm no where near as skilled as ducttape, but I would leave this thread as a stand alone. I stopped reading "The prescription opioid epidemic in a nutshell" 29 pages ago so I wouldn't have seen this, but appreciate having it as a source. Thanks!

 

[Orin]

fwiw, I notice you wrote "weak evidence".
the conclusions suggest weak evidence for improved or no change pain. it did not suggest worse pain after taper. the implication of your title is a negative one.

The original conclusion is correct though as the quality of the evidence is weak, i.e. they were not controlled trials. This paper is a setup for justification for a proper RCT, ideally placebo controlled.

 

[lobelsteve]

The original conclusion is correct though as the quality of the evidence is weak, i.e. they were not controlled trials. This paper is a setup for justification for a proper RCT, ideally placebo controlled.

Placebo withdrawal?

Smh.