Tapering of iatrogenic opioid use in patients with chronic non-malignant pain

INTRODUCTION: Iatrogenic opioid use by patients with chronic malignant pain remains an important focus point. The positive effects of opioids seem to decline over time, whereas tapering will have positive effects in many patients. The purpose of the project was to optimise the process for patients with a wish or a need to taper opioids. METHODS: Patients were referred to a multidisciplinary pain treatment centre with the aim of tapering their opioid use. The use of opioids before and after the intervention at the pain treatment centre was registered. Questionnaires about quality of life, sleep quality and level of depression were completed before and after the study, participants were allowed to add comments to the questionnaires and interviews were conducted. RESULTS: A total of 22 patients participated. They had complex pain issues and had received opioids for a median period of nine years. The participants achieved a significant reduction of opioids (median 23 mg). Four patients completely stopped using opioids in the project period, four did not benefit from the project and two achieved reductions to the lowest dose possible allowing them to maintain an acceptable level of function. The remaining patients had a tapering plan to be continued in cooperation with their general practitioner. Most patients experienced the process as very satisfactory or satisfactory but achieved no measurable improvements in quality of life, sleep quality or level of depression. CONCLUSION: Even though the tapering of opioids had appeared difficult beforehand, a significant reduction in opioid consumption was achieved. FUNDING: The project was funded by the Danish Health Authority. TRIAL REGISTRATION: not relevant.