Reducing opioids CAN reduce pain

Yes, patients can be weaned off opioids AND reduce their pain levels.

That’s the conclusion of a Vox article providing an excellent, detailed, and thorough review of a study published in the Annals of Internal Medicine Vox (thanks to Health News Review for the head’s up).

Here’s the abstract’s conclusion…

Very low quality evidence suggests that several types of interventions may be effective to reduce or discontinue LTOT [long term opioid therapy] and that pain, function, and quality of life may improve with opioid dose reduction.

Let’s parse this out.

The AIM study was based on a review of 67 clinical studies; it wasn’t “primary research.” Researchers found most of the studies on this issue had either a poor methodology or low sample size. And, relatively few were even of “fair” or “good” quality.

The 12.000 pain patients in these studies volunteered to taper off opioids; they were obviously motivated and wanted to make the change. So, it’s not possible to use this research when thinking about how to address non-volunteers as “involuntarily pulling patients off the drugs (may not) lead to similar outcomes.”

And this…

Crucially, the studies also looked at what happened when these reductions in opioid doses were paired with alternative treatments, including alternative medicines like acupuncture, interdisciplinary pain programs, and medication-assisted treatment for addiction. This is very, very different from a situation in which a patient is taken off opioids and effectively left stranded without any other form of care.

Conversely,

[the CDC concluded] there are simply no good long-term studies looking at the effects of opioids on long-term pain outcomes, while there are many studies showing that long-term opioid use can lead to bad results in other areas, including addiction and overdose.

Here’s a major point made in the study and Vox article – we HAVE to stop looking to opioids as a first-and-only line of treatment for pain.

the lack of access to non-opioid strategies may be one big reason that doctors resorted to opioids in the first place. The drugs offered an easy answer — if ultimately an ineffective one — to the many problems doctors faced, including patients who had complicated pain problems that physicians didn’t fully understand and tight schedules driven by the current demands of the health care system that made it hard to take the time to work through a patient’s individual problems. [emphasis added]

AND, we HAVE to allow/encourage/pay for alternative treatment.

What does this mean for you?

Suggest different initial treatments for pain, and get creative when helping patients who want to get off opioids.

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