chronic-pain-opioid-treatment-report-140929

adequately controlled by immobilization and alternative medications were excluded from studyentry. We identified no study published since the APS review addressing this question.Key Question 3jIn patients on long-term opioid therapy, what is the comparativeeffectiveness of different tapering protocols and strategies onmeasures related to pain, function, quality of life, withdrawalsymptoms, and likelihood of opioid cessation?Key Points• Two poor-quality, nonrandomized prospective trials found no clear differences betweendifferent methods for opioid discontinuation or tapering (inpatient, patient controlledversus fixed reduction schedule or detoxification plus counseling versus detoxificationplus maintenance) in likelihood of opioid abstinence after 3 to 6 months (SOE:Insufficient).Detailed SynthesisThe APS review included two poor-quality, nonrandomized prospective trials that reportedsimilar rates of opioid abstinence after 3 to 6 months in patients allocated to different methodsfor opioid discontinuation or tapering (Appendix E12 and F4). 106, 107 In one study (n=108),patients either chose inpatient, patient-controlled reduction of opioids or a fixed reductionschedule. 106 Mean opioid dose on study entry was 36 mg MED/day; duration of opioid therapywas not reported. In the second study, patients (n=42) received detoxification plus counseling ordetoxification with maintenance therapy if detoxification was unsuccessful. 107 Mean duration ofopioid use was 7.2 years in the detoxification plus counseling group and 9.2 years in thedetoxification plus maintenance group; opioid doses ranged widely (e.g., codeine daily dosesranged from 240 to 2400 mg/day). Neither study evaluated effects of different methods fordiscontinuing opioids on pain, function, quality of life, or withdrawal symptoms.We identified no study published since the APS review on the comparative effectiveness ofdifferent tapering protocols and strategies in chronic pain patients on long-term opioid therapy.Key Question 4aIn patients with chronic pain being considered for long-term opioidtherapy, what is the accuracy of instruments for predicting risk of opioidoverdose, addiction, abuse, or misuse?Key Points• Three studies (one fair-quality, two poor-quality) evaluated the Opioid Risk Tool (ORT);using a cutoff of ≥4. Estimates of diagnostic accuracy were inconsistent, precludingreliable conclusions. Sensitivities ranged from 0.20 to 0.99; specificities for the two inwhich this could be calculated were 0.88 and 0.16 (SOE: Insufficient).41