Interventions for the reduction of prescribed opioid use in chronic non-cancer pain

Jude Windmill, Emma Fisher, C Eccleston, Sheena Derry , Cathy Stannard, Roger Knaggs, R. Andrew Moore

Research output: Contribution to journalArticlepeer-review

38 Citations (Scopus)
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Abstract

Background
Patients with chronic non-cancer pain who are prescribed and are taking opioids can have a history of long term high dose opioid use without effective pain relief. In those without good pain relief, reduction of prescribed opioid dose may be the desired and shared goal of both patient and clinician. Simple unsupervised reduction of opioid use is clinically challenging, and very difficult to achieve and maintain.
Objectives
To investigate the effectiveness of different methods designed to achieve Authors’ conclusions Both included studies were at significant risk of bias because of their small size, together with other important issues, including blinding.
Because of this risk and the paucity of relevant studies, no conclusions can be drawn regarding the effectiveness of interventions for opioid withdrawal in chronic non-cancer pain.reduction or cessation of prescribed opioid use for the
management of chronic non-cancer pain.
Search methods
We searched the Cochrane Central Register of Controlled Trials (CENTRAL),MEDLINE, and EMBASE from inception to 8th April 2013, as well as bibliographies.
Selection criteria
Included studies had to be randomised controlled trials comparing opioid users receiving an intervention with a control group receiving treatment as usual, active control, or placebo. The aim of the study had to include a treatment goal of dose reduction or cessation of opioid medication.
Data collection and analysis
We sought data relating to prescribed opioid use, adverse events of opioid reduction, pain, and psychological and physical function.
Main results
Two studies provided information on 86 participants. One compared electroacupuncture with sham acupuncture for 20 minutes twice a week for six weeks; there was no difference between treatments. The other followed 11 weeks of cognitive behavioural therapy with either therapeutic interactive voice response through a computer for four months or usual treatment; the active group had a significant reduction in opioid use, while the usual care group had a significant increase.
Authors’ conclusions
Both included studies were at significant risk of bias because of their small size, together with other important issues, including blinding. Because of this risk and the paucity of relevant studies, no conclusions can be drawn regarding the effectiveness of interventions for opioid withdrawal in chronic non-cancer pain.
Original languageEnglish
Pages (from-to)CD010323
JournalThe Cochrane Library
Volume9
Early online date1 Sep 2013
DOIs
Publication statusPublished - 2013

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