A prospective observational pilot study of patients using opioids to treat chronic pain found that opioid tapering was linked to improved experimental pain responses without a measurable decline in function or quality of life (QoL). These findings were published in Pain and Therapy.
Patients using ≥120 mg opioid morphine equivalents daily (MED) for ≥6 months for chronic neuropathic pain were recruited from the University of Pennsylvania Pain Medicine Center. All patients voluntarily agreed to taper their opioid dosage. During the taper, patients were assessed biweekly for pain sensitivity and central pain modulation, and for QoL monthly.
The cohort comprised 71.3% women, aged median 61 (interquartile range [IQR], 27) years, 85.71% were White, and mean opioid MED dose was 291.9 (range, 127-645) mg.
Over a median of 17.5 (IQR, 21.5) weeks, patients were tapered down to a mean dose of 258.0 (range, 90-615) mg, a 12% reduction.
Median chronic pain using the visual analogue scale (VAS) was 98 (IQR, 10) at baseline and 90 (IQR, 0) after taper. The mean chronic pain score improved by 16%. In addition, median cold-pressor pain threshold decreased from 12.75 to 7.78 s and cold-pressor pain tolerance from 17.23 to 16.64 s.
In a linear mixed-effects model, opioid taper significantly improved cold-pressor test pain threshold by 1.14 s every 6 weeks (P =.0084) and tolerance increased by 2.87 s every 6 weeks (P =.0026).
QoL, measured by the Patient-Reported Outcomes Measurement Information System, remained stable after taper (median, 110 vs 110.5 points).
Withdrawal symptoms did not significantly change during the taper (P =.1392).
This trial was a pilot study with a small sample size and results should be interpreted with caution.
This study found that patients using high-dose opioids for the treatment of chronic pain had improved experimental pain scores without a change in QoL after tapering their dosage by 12%.
The researchers noted that these findings suggest that “[opioid-induced hyperalgesia] may contribute to the pain experience of patients with chronic pain.”
Compton P, Halabicky OM, Aryal S, Badiola I. Opioid taper is associated with improved experimental pain tolerance in patients with chronic pain: an observational study.Pain Ther. 2022;1-11. doi:10.1007/s40122-021-00348-8