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Cited by 319Opioid Use Disorder TreatmentPain Management and Opioid UseMusculoskeletal pain and rehabilitation

Patient Outcomes in Dose Reduction or Discontinuation of Long-Term Opioid Therapy: A Systematic Review

Frank, Joseph W., Lovejoy, Travis I., Becker, William C., Morasco, Benjamin J., Koenig, Christopher J., Hoffecker, Lilian, Dischinger, Hannah R., Dobscha, Steven K. +1 more·2017·Annals of Internal Medicine
DOI 10.7326/m17-0598
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Abstract

BACKGROUND: Expert guidelines recommend reducing or discontinuing long-term opioid therapy (LTOT) when risks outweigh benefits, but evidence on the effect of dose reduction on patient outcomes has not been systematically reviewed. PURPOSE: To synthesize studies of the effectiveness of strategies to reduce or discontinue LTOT and patient outcomes after dose reduction among adults prescribed LTOT for chronic pain. DATA SOURCES: MEDLINE, EMBASE, PsycINFO, CINAHL, and the Cochrane Library from inception through April 2017; reference lists; and expert contacts. STUDY SELECTION: Original research published in English that addressed dose reduction or discontinuation of LTOT for chronic pain. DATA EXTRACTION: Two independent reviewers extracted data and assessed study quality using the U.S. Preventive Services Task Force quality rating criteria. All authors assessed evidence quality using the GRADE (Grading of Recommendations Assessment, Development and Evaluation) system. Prespecified patient outcomes were pain severity, function, quality of life, opioid withdrawal symptoms, substance use, and adverse events. DATA SYNTHESIS: Sixty-seven studies (11 randomized trials and 56 observational studies) examining 8 intervention categories, including interdisciplinary pain programs, buprenorphine-assisted dose reduction, and behavioral interventions, were found. Study quality was good for 3 studies, fair for 13 studies, and poor for 51 studies. Many studies reported dose reduction, but rates of opioid discontinuation ranged widely across interventions and the overall quality of evidence was very low. Among 40 studies examining patient outcomes after dose reduction (very low overall quality of evidence), improvement was reported in pain severity (8 of 8 fair-quality studies), function (5 of 5 fair-quality studies), and quality of life (3 of 3 fair-quality studies). LIMITATION: Heterogeneous interventions and outcome measures; poor-quality studies with uncontrolled designs. CONCLUSION: Very low quality evidence suggests that several types of interventions may be effective to reduce or discontinue LTOT and that pain, function, and quality of life may improve with opioid dose reduction. PRIMARY FUNDING SOURCE: Veterans Health Administration. (PROSPERO: CRD42015020347).

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  • In patients prescribed long-term opioid therapy for pain, success rates are better - 20% to 91% depending on the intervention used, although some of these interventions involved switching patients to buprenorphine rather than opioid cessation per se.

    “In patients prescribed long-term opioid therapy for pain, success rates are better – 20% to 91% depending on the intervention used (although some of these interventions involved switching patients to buprenorphine rather than opioid cessation per se). 44”

    From Tapering and withdrawing opioids: guidance informed by fundamental principles to minimise withdrawal symptoms (2025) · cites this paper as [44]

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Authors
Frank, J. W., Lovejoy, T. I., Becker, W. C., Morasco, B. J., Koenig, C. J., Hoffecker, L., Dischinger, H. R., Dobscha, S. K., & Krebs, E. E.
Affiliations
University of Minnesota (US)
ORCID
Venue
Annals of Internal Medicine
Publisher
American College of Physicians
Published
2017-08-01
Volume
167
Issue
3
Pages
181-191
ISSN
  • 0003-4819 (ISSN-L)
  • 1539-3704
DOI
10.7326/m17-0598
OpenAlex
W2736543687
Cited by
318
References
99
Citations by year
2026: 16 · 2025: 22 · 2024: 25 · 2023: 29 · 2022: 43 · 2021: 45 · 2020: 53 · 2019: 33 · 2018: 41 · 2017: 10
FWCI
6.09
Type
journal article
Language
en
Open access
closed
Licence
www.acpjournals.org/journal/aim/text-and-data-mining (tdm)
Locations
  • Annals of Internal Medicine (publishedVersion)
  • PubMed (publishedVersion)
Funders
U.S. Department of Veterans Affairs (IK2 HX001516, IK2 HX001914)
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 › Pharmacology › Musculoskeletal pain and rehabilitation
Keywords
long-term opioid therapy, opioid dose reduction, opioid discontinuation, chronic pain, pain intensity, functional status, quality of life, opioid withdrawal symptoms, substance use, adverse events, behavioral interventions
MeSH terms
Analgesics, Opioid, Drug Administration Schedule, Humans, Quality of Life, Severity of Illness Index, Substance Withdrawal Syndrome, Treatment Outcome, Withholding Treatment, Chronic Pain

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