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Cited by 71Opioid Use Disorder TreatmentPain Management and Opioid UseAnesthesia and Pain Management

Opiate reduction in chronic pain patients: A comparison of patient-controlled reduction and staff controlled cocktail methods

Ralphs, Judith A., de C Williams, Amanda C, Richardson, Phil H., Pither, Charles E., Nicholas, Michael K.·1994·Pain
DOI 10.1016/0304-3959(94)90166-x
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Abstract

This study compares the effectiveness of two methods of opiate reduction in 108 chronic pain patients during a 4 week inpatient pain management programme, and at 1-month and 6-month follow-up. Patients chose either the patient-controlled reduction (PCR) or cocktail reduction method, aiming to complete withdrawal by discharge. Use of opiates and other drugs was recorded, and psychological measures taken, at admission, at discharge, and at follow-ups. Patients who opted for the cocktail reduction method started at higher morphine equivalents (P < 0.001), were less confident in their ability to cope without medication (P < 0.05), and rated their everyday activities a more disrupted by pain (P < 0.05). At discharge, 89% of the cocktail group were abstinent from opiates compared with 68% of the PCR group (P < 0.05). By 1-month follow-up, the advantage of the cocktail method had disappeared, with no significant differences between the two groups in mean opiate dose, nor in the proportion of abstinent patients. This was the result of a greater return to opiate use in the cocktail group, with abstinence rates remaining unchanged in the PCR group. By 6-month follow-up, abstinence rates for the groups were equivalent, with 55% of patients remaining off opiates. By this stage, however, non-abstinent cocktail group patients were taking significantly larger doses of opiates than PCR patients (P < 0.05), although in both groups, the dose was well below admission level. Admission opiate dose level was the best predictor both of abstinence at discharge and of subsequent opiate dose level in non-abstinent patients. This study demonstrates that both reduction methods can produce substantial reduction in opiate use by severely impaired chronic pain patients with long medication histories.

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Crossref · 10.1016/0304-3959(94)90166-x

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  • In this study and others, blinded or open tapers have not demonstrated significant differences in rates of opioid cessation.

    “However, in this study and others, 56 blinded or open tapers have not demonstrated significant differences in rates of opioid cessation.”

    From Tapering and withdrawing opioids: guidance informed by fundamental principles to minimise withdrawal symptoms (2025) · cites this paper as [56]

  • The studies on blinded or open tapers have substantial limitations including participants continuing to use heroin, very small sample sizes, contradictory findings, missing details about blinding procedures, likely too-fast rates of reduction, and nonrandomisation.

    “There are substantial limitations to these studies however with participants continuing to use heroin in some cases, very small sample sizes, contradictory findings, missing details about blinding procedures (e.g. whether there were any visual or olfactory clues that would have indicated timing of reduction), likely too-fast rates of reduction and, in the case of Ralphs et al., nonrandomisation to”

    From Tapering and withdrawing opioids: guidance informed by fundamental principles to minimise withdrawal symptoms (2025) · cites this paper as [56]

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Authors
Ralphs, J. A., de C Williams, A. C., Richardson, P. H., Pither, C. E., & Nicholas, M. K.
Affiliations
St Thomas' Hospital (GB)
Corresponding author
Ralphs, Judith A.
ORCID
Nicholas, Michael K.
Venue
Pain
Publisher
Ovid Technologies (Wolters Kluwer Health)
Published
1994-03
Volume
56
Issue
3
Pages
279-288
ISSN
0304-3959 (ISSN-L)
DOI
10.1016/0304-3959(94)90166-x
OpenAlex
W1989723816
Cited by
70
References
44
Citations by year
2026: 1 · 2025: 3 · 2024: 1 · 2023: 1 · 2022: 4 · 2021: 2 · 2020: 3 · 2019: 2 · 2018: 8 · 2017: 2 · 2016: 4 · 2015: 4 · 2014: 2 · 2013: 3 · 2012: 2
FWCI
3.60
Type
journal article
Language
en
Open access
closed
Locations
  • Pain (publishedVersion)
  • PubMed (publishedVersion)
  • UCL Discovery (University College London) (submittedVersion)
Funders
South East Regional Health Authority
Topics
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Opioid Use Disorder Treatment
  • Health Sciences › Medicine › Anesthesiology and Pain Medicine › Pain Management and Opioid Use
  • Health Sciences › Medicine › Surgery › Anesthesia and Pain Management
Keywords
chronic pain, opioid withdrawal, morphine milligram equivalents, inpatient pain management, drug history
MeSH terms
Adult, Aged, Behavior Therapy, Chronic Disease, Female, Follow-Up Studies, Humans, Male, Middle Aged, Narcotics, Pain, Surveys and Questionnaires, Substance Withdrawal Syndrome, Cognitive Behavioral Therapy, Analgesia, Patient-Controlled

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