Caution of Conclusions of a Meta-analysis Including Problematic Trials

Abstract

for the primary care physician, for example Indiana's "trigger" dose of 15 mg MEDD for more than 3 months, which is considerably lower than the CDC recommendations.Second, the authors conclude that their effect is a result of a "reduction with a plan that reduces opioids more slowly than current tapering algorithms," although their design does not permit a comparison between programs of differing lengths.One of our authors was a contributor to the proposed algorithm that they reference, with Berna and colleagues 5 conservatively concluding that "there is no published comparison of speed of tapers in patients with longterm opioid treatment for CNCP, although such research would be of great interest."Finally, the authors introduce a potentially cost-effective psychoeducational intervention, ie, a self-help book on reducing opioid use.Although the importance of self-help materials cannot be underestimated, the real challenges may occur as patients are tapered to lower doses, a process in which more targeted and intensive behavioral intervention remains critical.