Background: There is inadequate evidence of long-term benefit from opioid medications for chronic pain and substantial evidence of potential harms. For patients, dose reduction may be beneficial when implemented voluntarily and supported by a multidisciplinary team but experts have advised against involuntary opioid reduction. Objectives: To assess the prevalence of self-reported involuntary opioid reduction and to examine whether involuntary opioid reduction is associated with changes in pain severity. Design: Prospective observational cohort study. Participants: Primary care patients treated with long-term opioid therapy in the Veterans Health Administration (N = 290). Main Measures: The primary exposure was self-reported past year involuntary opioid reduction. The primary outcome was the three-item PEG scale, which measures past-week average pain intensity and interference with enjoyment of life and general activity. Key Results: Past year opioid reduction or discontinuation was reported by 63% (184/290). Similar numbers reported involuntary (88/290) and voluntary (96/290) opioid reduction. At baseline, there were no significant differences in pain severity between the groups (mean PEG, 7.08 vs. 6.73 vs. 7.07 for past year involuntary opioid reduction, past year voluntary opioid reduction, and no past year opioid reduction, respectively; P = 0.32). For the primary outcome of change in pain severity from baseline to 18 months, there were no significant differences between groups (mean PEG change, − 0.05 vs. − 0.44 vs. − 0.23 for past year involuntary opioid reduction, past year voluntary opioid reduction, and no past year opioid reduction, respectively; P = 0.28). Conclusions: Self-reported past year involuntary opioid reduction was common among a national sample of veterans treated with long-term opioid therapy. Opioid dose reduction, whether involuntary or voluntary, was not associated with change in pain severity. Future studies should examine involuntary opioid reduction in different populations and trends over time and explore further patient- and provider-level factors that may impact patient experience and outcomes during opioid reduction.
Bibliographical noteFunding Information:
The authors would like to acknowledge the important contributions of Indy Rutks and Agnes Jensen at the Minneapolis VA Health Care System and Lexus Ujano-De Motta, Lindsay Miller and Amy Ladebue at the VA Eastern Colorado Health Care System.
This work was supported by the Department of Veterans Affairs Health Services Research & Development (IIR 14-295). Dr. Frank was supported by VA Health Services Research & Development Career Development Award (HSR&D CDA 15-059). The funding sources had no role in the design and conduct of the study; collection, management, analysis, or interpretation of the data; or preparation, review, or approval of the manuscript. The views expressed in this article are those of the authors and do not necessarily reflect the position or policy of the Department of Veterans Affairs or the US Government. Acknowledgments
- Veterans health
- health services research
- medication therapy management
- opioid analgesics
- pain management
PubMed: MeSH publication types
- Journal Article
- Research Support, U.S. Gov't, Non-P.H.S.