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Cited by 56Opioid Use Disorder TreatmentPain Management and Opioid UseMusculoskeletal pain and rehabilitation

The DOI matches its Crossref record; 217 of the 218 references it cites were found in a registry or an index.

Efficacy of interventions to reduce long term opioid treatment for chronic non-cancer pain: systematic review and meta-analysis

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Avery, Nicholas, McNeilage, Amy G, Stanaway, Fiona, Ashton-James, Claire E, Blyth, Fiona M, Martin, Rebecca, Gholamrezaei, Ali, Glare, Paul·2022·BMJ
DOI 10.1136/bmj-2021-066375PMC PMC8977989
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Abstract

Abstract Objective To review interventions to reduce long term opioid treatment in people with chronic non-cancer pain, considering efficacy on dose reduction and discontinuation, pain, function, quality of life, withdrawal symptoms, substance use, and adverse events. Design Systematic review and meta-analysis of randomised controlled trials and non-randomised studies of interventions. Data sources Medline, Embase, PsycINFO, CINAHL, and the Cochrane Library searched from inception to July 2021. Reference lists and previous reviews were also searched and experts were contacted. Eligibility criteria for study selection Original research in English. Case reports and cross sectional studies were excluded. Data extraction and synthesis Two authors independently selected studies, extracted data, and used the Cochrane risk-of-bias tools for randomised and non-randomised studies (RoB 2 and ROBINS-I). Authors grouped interventions into five categories (pain self-management, complementary and alternative medicine, pharmacological and biomedical devices and interventions, opioid replacement treatment, and deprescription methods), estimated pooled effects using random effects meta-analytical models, and appraised the certainty of evidence using GRADE (grading of recommendations, assessment, development, and evaluation). Results Of 166 studies meeting inclusion criteria, 130 (78%) were considered at critical risk of bias and were excluded from the evidence synthesis. Of the 36 included studies, few had comparable treatment arms and sample sizes were generally small. Consequently, the certainty of the evidence was low or very low for more than 90% (41/44) of GRADE outcomes, including for all non-opioid patient outcomes. Despite these limitations, evidence of moderate certainty indicated that interventions to support prescribers’ adherence to guidelines increased the likelihood of patients discontinuing opioid treatment (adjusted odds ratio 1.5, 95% confidence interval 1.0 to 2.1), and that these prescriber interventions as well as pain self-management programmes reduced opioid dose more than controls (intervention v control, mean difference –6.8 mg (standard error 1.6) daily oral morphine equivalent, P<0.001; pain programme v control, −14.31 mg daily oral morphine equivalent, 95% confidence interval −21.57 to −7.05). Conclusions Evidence on the reduction of long term opioid treatment for chronic pain continues to be constrained by poor study methodology. Of particular concern is the lack of evidence relating to possible harms. Agreed standards for designing and reporting studies on the reduction of opioid treatment are urgently needed. Review registration PROSPERO CRD42020140943.

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Crossref · 10.1136/bmj-2021-066375

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Figures

Fig 1 Literature flowchart. Key questions refer to (1) how effective interventions are to reduce or discontinue long term opioid treatment, and (2) what their effects are on patient outcomes
Fig 1 Literature flowchart. Key questions refer to (1) how effective interventions are to reduce or discontinue long term opioid treatment, and (2) what their effects are on patient outcomesCC BY-NC · PubMed Central
Fig 2 Risk-of-bias summary for randomised controlled trials included in the evidence synthesis, using Cochrane risk-of-bias tool RoB 2
Fig 2 Risk-of-bias summary for randomised controlled trials included in the evidence synthesis, using Cochrane risk-of-bias tool RoB 2CC BY-NC · PubMed Central
Fig 3 Meta-analyses of randomised controlled trials investigating interventions to taper long term opioid treatment for chronic non-cancer pain, according to opioid discontinuation and opioid dose. IV=inverse variance; M-H=Mantel Haenszel test; SD=standard deviation; df=degrees of freedom; OME= oral morphine equivalent
Fig 3 Meta-analyses of randomised controlled trials investigating interventions to taper long term opioid treatment for chronic non-cancer pain, according to opioid discontinuation and opioid dose. IV=inverse variance; M-H=Mantel Haenszel test; SD=standard deviation; df=degrees of freedom; OME= oral morphine equivalentCC BY-NC · PubMed Central
Fig 4 Meta-analyses of randomised controlled trials investigating interventions to taper long term opioid treatment for non-cancer chronic pain, according to pain intensity and function. IV=inverse variance; SD=standard deviation; df=degrees of freedom
Fig 4 Meta-analyses of randomised controlled trials investigating interventions to taper long term opioid treatment for non-cancer chronic pain, according to pain intensity and function. IV=inverse variance; SD=standard deviation; df=degrees of freedomCC BY-NC · PubMed Central
Fig 5 Risk-of-bias summary for non-randomised studies investigating interventions to taper long term opioid treatment for non-cancer chronic pain, using Cochrane risk-of-bias tool ROBINS-I
Fig 5 Risk-of-bias summary for non-randomised studies investigating interventions to taper long term opioid treatment for non-cancer chronic pain, using Cochrane risk-of-bias tool ROBINS-ICC BY-NC · PubMed Central

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Citations

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Items 201–217 of 217

Research works printed but not linked: 2

  1. National Academies of Sciences, Engineering, and Medicine; Health and Medicine Division; Board on Health Sciences Policy; Committee on Pain Management and Regulatory Strategies to Address Prescription Opioid Abuse; Phillips JK, Ford MA, Bonnie RJ, eds. Pain Management and the Opioid Epidemic: Balancing Societal and Individual Benefits and Risks of Prescription Opioid Use. 5: Evidence on strategies for addressing the opioid epidemic. Pain management and the opioid epidemic: balancing societal and individual benefits and risks of prescription opioid use. US National Academies Press, 2017. https://www.ncbi.nlm.nih.gov/books/NBK458653/.
  2. Walker, 2013, Opioid-induced hyperalgesia and monotherapy intrathecal ziconotide: experience with four cases, J Pain Manag, 6, 257

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Authors
Avery, N., McNeilage, A. G., Stanaway, F., Ashton-James, C. E., Blyth, F. M., Martin, R., Gholamrezaei, A., & Glare, P.
Affiliations
  • The University of Sydney (AU)
  • Royal North Shore Hospital (AU)
Corresponding author
Glare, Paul
ORCID
Venue
BMJ
Publisher
BMJ
Published
2022-04-04
Volume
377
Pages
e066375
ISSN
1756-1833 (ISSN-L)
DOI
10.1136/bmj-2021-066375
PMC
PMC8977989
OpenAlex
W4224236297
Cited by
56
References
218
Citations by year
2026: 12 · 2025: 17 · 2024: 11 · 2023: 10 · 2022: 6
FWCI
2.19
Type
journal article
Language
en
Open access
Licence
Locations
  • BMJ (publishedVersion, cc-by-nc)
  • PubMed Central (publishedVersion, cc-by-nc)
  • PubMed (publishedVersion)
Funders
Ernest Heine Family Foundation
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 › Health Professions › Physical Therapy, Sports Therapy and Rehabilitation › Musculoskeletal pain and rehabilitation
Keywords
chronic non-cancer pain, opioid dose reduction, opioid discontinuation, opioid substitution therapy, complementary and alternative medicine, guideline adherence, withdrawal symptoms, quality of life, morphine milligram equivalents, patient-reported outcomes, substance use, adverse events
MeSH terms
Analgesics, Opioid, Cross-Sectional Studies, Humans, Quality of Life, Chronic Pain, Pain Management

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