Pain Intensity Following Discontinuation of Long-Term Opioid Therapy Does Not, on Average, Worsen for Patients
BACKGROUND:
Little evidence exists for the efficacy of prescription opioids beyond three months, and even less is known about changes in pain following discontinuation of long-term opioid therapy (LTOT). This retrospective study sought to characterize pain intensity over 12 months following opioid discontinuation. Using VA data from a previous project that examined discontinuation of LTOT among patients with and without substance use disorder (SUD), the current study identified 551 Veterans who had discontinued LTOT (51% had an SUD and 61% had one or more mental health diagnoses). Data were analyzed over 24 months, including 12 months prior to and 12 months following opioid therapy discontinuation. The primary outcome of interest was current pain intensity, as measured by the numeric rating scale (NRS) score where 0 = "no pain" and 10 = "worst possible pain." In addition to examining the patient's daily dose of opioids for the year prior to discontinuation, investigators assessed patient demographics, medical comorbidities, and mental health disorders.
FINDINGS:
- Average pain intensity did not significantly worsen in the 12 months after Veterans discontinued opioid therapy; for some patients, pain intensity improved.
- Mean estimated pain at the time of opioid discontinuation was 4.9. Changes in pain following discontinuation were characterized by slight but statistically non-significant declines in pain intensity over 12 months post-discontinuation. Veterans in the mild (average pain = 3.9) and moderate (average pain = 6.3) pain categories experienced the greatest pain reductions post-discontinuation.
- Of this study cohort, 87% of Veterans were diagnosed with chronic musculoskeletal pain, 6% with neuropathic pain, and 11% with headache pain (including migraine).
IMPLICATIONS:
- Study findings can aid clinicians during discussions with patients about opioid discontinuation. However, pain intensity is only one important outcome. For example, pain interference and quality of life have both been identified as important outcomes following opioid discontinuation.
LIMITATIONS:
- Investigators were unable to ascertain the extent to which Veterans may have been prescribed opioids, opioid agonist treatments (i.e., methadone maintenance or buprenorphine), or used other non-opioid treatments outside VA in the pre- or post-opioid discontinuation periods.
- VA data on non-opioid pharmacotherapy in the pre-discontinuation period were unavailable, thus investigators did not control for this form of pain treatment.
AUTHOR/FUNDING INFORMATION:
Dr. Lovejoy is supported by an HSR&D Career Development Award. All authors, except Drs. McPherson and Smith, are part of HSR&D's Center to Improve Veteran Involvement in Care (CIVIC).
McPherson S, Smith C, Dobscha S, Morasco B, Demidenko M, Meath T, and Lovejoy T. Changes in Pain Intensity Following Discontinuation of Long-Term Opioid Therapy for Chronic Non-Cancer Pain. Pain. June 13, 2018;epub ahead of print.
