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

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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., Krebs, Erin E.·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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Self-citation

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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: Frank, Joseph W.
Lovejoy, Travis I.
Becker, William C.
Morasco, Benjamin J.
Koenig, Christopher J.
Hoffecker, Lilian
Dischinger, Hannah R.
Dobscha, Steven K.
Krebs, Erin E.
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 › Health Professions › Physical Therapy, Sports Therapy and Rehabilitation › 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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Patient Outcomes in Dose Reduction or Discontinuation of Long-Term Opioid Therapy: A Systematic Review

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