Tapering Opioid Doses May Help Alleviate Chronic Pain

Tapering Opioid Doses May Help Alleviate Chronic Pain

The Centers for Disease Control and Prevention established new opioid prescribing guidelines last year, and recommended that patients with a history of long-term of opioid use be weaned and tapered off these painkillers. A new study published this month in the journal Annals of Internal Medicine supports this idea, establishing that patients with chronic pain who taper off opioid doses can help alleviate their chronic pain and have a better quality of life without the drugs. So how can tapering opioid doses alleviate chronic pain?

100 million Americans suffer from chronic pain, according to the American Academy of Pain Medicine. Unfortunately, for many patients with with chronic pain, the typical treatment regimen has consisted of addictive painkillers. It’s known that long-term use of narcotic opioid medications increases the risk of dependency and overdose, and the country is currently in the midst of an opioid overdose epidemic, which claimed the lives of more than 33,000 Americans in 2015, half of which were associated with opioid prescription drugs.

This new research suggests that tapering or reducing the dose of opioid painkillers may actually help improve pain and function, and improve quality of life in long-term users.

Painkillers Have a High Potential for Abuse

More than 2 million Americans are addicted to prescription painkillers, and almost 600,000 are addicted to heroin, according to recent federal data.

Opioid painkillers like oxycodone (Oxycontin, Percocet) and hydrocodone (Vicoprofen) have a high potential for abuse and dependency. Often these drugs are prescribed long-term for the treatment of chronic pain conditions, including low back pain or arthritis.

The problem comes in when patients begin to depend on these medications, many often not even realizing they’re hooked. While tapering can be beneficial, it’s important to note that anyone who has been using opioid long-term, and anyone who has developed a dependence on these drugs will likely experience difficult withdrawal symptoms and a high potential for relapse. Therefore, people should never stop taking opioid abruptly as quitting cold turkey can lead to very uncomfortable symptoms.

Tamara Haegerich, Associate Director for Science at the CDC and co-author of an editorial published along with the report, says that some of these symptoms of opioid withdrawal can include drug cravings, insomnia, anxiety, stomach pain and tremors. Other symptoms can include severe pain and panic attacks.

“Tapering plans may need to be individualized based on patient goals and concerns,” Haegerich said.

Aside from the potential for addiction and overdose, chronic opioid use can lead to other health issues, including trouble sleeping and mood changes, a heightened risk for fractures, heart attack, sexual dysfunction.

Evidence that Tapering Opioid Doses May Alleviate Chronic Pain

medicine for chronic painThe research was conducted by Dr. Joseph Frank, physician at Denver’s Veterans Affairs Medical Center and his collegues. They conducted 67 studies that involved reducing or stopping opioid therapy for chronic pain. Forty of the studies specifically analyzed how patients did when their opioid medication dose was lowered. The researchers found that this led to an improvement in pain intensity, function and quality of life.

So what does tapering consist of? In essence, tapering medication schedules lowers the patient’s daily dose by about 10 percent every five to seven days, until that patient is off the drug completely or become accustomed to a much lower dose.

“Opioid medications have several important risks, such as overdose and addiction,” Frank said. “Risks of opioid medications are highest when the medications are taken at high doses.”

Although lowering or stopping doses altogether might lower these risks, Frank noted. This may also lead to other problems, such as the use of illegal drugs or suicide.

The research findings suggest that reducing opioid doses should be done in a gradual manner, with the additional support of other non-opioid care. Types of non-opioid treatment can include cognitive behavioral therapy and meditation, among others.

“In most studies in this review, opioid tapering involved slowly decreasing the dose of the medications over time, while working closely with a team of pain experts and using multiple non-opioid pain treatments,” Frank said. “By helping individuals develop healthy skills to cope with pain, the hope is that we also diffuse pressures fueling the opioid epidemic,” he added.

CDC Opioid Prescribing Guidelines: A Review

According to CDC guidelines, doctors should follow up with patients to determine if the opioids they’ve prescribed are meeting treatment goals and if the opioids can be reduced to lower dosage or discontinue the use of the drugs altogether

The CDC’s Guidelines for Prescribing Opioids for Chronic Pain suggest that medical professionals should consider reducing opioid doses or tapering them to discontinue opioid therapy when the patient:

  • Requests that their dosage be reduced
  • Does not experience a clinically meaningful improvement in pain – at least a 30% improvement
  • Is on a dosage greater than 50MME/day with no positive results or when opioids are combined with benzodiazepines.
  • Displays signs of a substance use disorder
  • Experiences an overdose or other serious event
  • Shows early signs of overdose risk including confusion,  sedation or slurred speech.

These tapering schedules should be individualized and aimed at diminishing opioid withdrawal symptoms while optimizing treatment with nonpharmacologic therapies and non-opioid medications.

Providers must coordinate with a specialist and treatment professionals as needed, especially for patients who are at high risk, such as pregnant women or patients with a history of opioid abuse or dependency.

Patients also need the appropriate psychosocial support – this includes help from mental health specialists who can arrange for the appropriate treatment.

Lastly, providers should encourage their patients by letting them know that most people experience improved functioning after opioid doses are tapered.

“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,” the CDC’s Tamara Haegerich, who wrote an editorial accompanying the study, wrote in an email to CNN.

Get Treatment can Help You Find an Opioid Addiction Treatment Program

If you or someone you love is struggling with opioid addiction, the admissions professionals at Get Treatment can help. Our mission is to help you find a qualified addiction treatment center that provides individualized treatment programs tailored to your specific needs for recovery. Call 855-638-9268 today for more information about how to get started.

Sources:

http://health.usnews.com/health-care/articles/2017-07-18/easing-opioid-dose-may-improve-pain-and-quality-of-life

https://www.cdc.gov/drugoverdose/pdf/clinical_pocket_guide_tapering-a.pdf

http://www.cnn.com/2017/07/17/health/chronic-pain-opioid-tapering-study/index.html

Erica Loret de Mola

Gettreatment.com

Erica Loret de Mola is a communications major who has been writing about addiction treatment for approximately three years. As content manager and editor in chief of Get Treatment, she strives to provide the most accurate and current information available to our clients.

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