By Ed Coghlan.
A pilot study about tapering off opioids published this week from a single pain clinic shows a potential method for effectively tapering patients on high-dose opioids without increasing their pain. That’s what study co-author Beth Darnall, PhD of Stanford Pain Clinic wrote this week in describing her research team’s work.
“Many patients are fearful about reducing opioids. Our study methods focused on providing education to help allay their fears, as well as strengthening that bond to help patients succeed and achieve best outcomes.”
As the study report indicated: “Because our data are generated from a single pain clinic, studies are needed to assess how well our protocol would generalize to other types of patients and settings.”
Dr. Darnall agreed to answer a few questions we had.
National Pain Report: “It looks like you believe this study can lead to more research about people who are looking to wean themselves from opioids, right? Is that that right way to look at the “n”…people who want to wean themselves?”
Dr. Darnall: “110 patients taking long term opioids were invited to participate in a voluntary, patient centered opioid taper. They were promised it would go slow, slower if they wanted, and they could pause the taper if they wished. The goal was not zero opioids, it was to reduce their dose as much as comfortably possible over 4 months. We were interested in understanding who would express verbal interest (N=82), who would actually *engage in* the voluntary taper (N=68 filled out a baseline survey), who would complete it (N=51 filled out a final month 4 survey) and what would be their results. Finding that about half of 110 patients who were simply *offered a tapering pathway and nothing else* actually chose to do so was quite interesting. We believe that is because it was a patient-centered approach.”
“This pilot study is of the first to suggest that approaching opioid tapering differently – not forcing patients but partnering with them - may have a positive impact on their outcomes. Basically, for free. The pre-post within-subject nature of the study, combined with objective and subjective data, the topic and desperate need for tapering guidance for physicians and patients make this an important study that can help guide future work.”
National Pain Report: “What happens next, do you have a multi-center study in the future? What will that study explore?
Dr. Darnall: “We are now studying these methods in 865 patients in 5 clinics in 4 Western states beginning July 1. Similarly, our upcoming study is voluntary, patient-centered opioid reduction. We are also testing two evidence based behavioral strategies to help improve taper response and improve outcomes (this is an embedded RCT). The JAMA study is the pilot work to suggest we may have a successful method *for some patients* and we are now setting out to do the definitive science. The Patient Centered Outcomes Research Institute is funding our study. Patients were involved in the design of the study and will be involved in all aspects of research.
National Pain Report: “There’s an interesting number…a relatively large percentage dropped out of the study. Do we know why? Did they not to wean themselves from opioids or were there other stimuli?”
Dr. Darnall: “Only 17 out of 68 who enrolled in the taper study dropped out. It’s a 25% drop out rate and it is less than expected, frankly. We see about the same in non-opioid research studies. We don’t know why, but for whatever reason our study failed those 25%. We need to study this group more and learn from them. But it also in no way negates the positive findings: that a simple formula appears to help reduce risks for many patients without increasing their pain. I should clarify that the taper formula is simple, but patients need to trust their doctor and be willing to try to reduce their opioids.”
National Pain Report: “What did the overall results tell you as a pain researcher and noted psychologist?”
Dr. Darnall: “Forced tapers don’t work. Patients heal through compassion, and the doctor-patient bond is so important. We must address patients fears and cultivate partnership to achieve best outcomes. Gaining patient willingness to reduce opioids is critical to the success of a taper; at least, this is what I believe… we are now conducting the larger study to understand this more.
National Pain Report: “One final thought…do you have thoughts on how many people who are using opioids to manage chronic pain are capable of tapering to the point of finding other ways to manage their chronic pain…Is that even a question we can ask at this point?”
Dr. Darnall: I think our upcoming PCORI funded study will address this point - at least in part.”
Here’s a link to the research study published this week.