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Doctor, I have been taking opioids for my chronic pain condition. I want to taper my dose. Will my pain get worse if I taper my opioids?

Right now, the evidence is not definitive enough to answer this question. From the studies we have seen, it appears that it is possible to taper the dose of opioids without increasing the amount of pain. Patients have reported their pain levels being no worse or even better after a taper. More research is needed to understand how pain levels are affected by reducing opioid doses.

What is the evidence?

Researchers looked at patients with chronic pain who were using opioids, or were addicted to opioids, who underwent an opioid tapering procedure at inpatient or outpatient facilities. They looked at whether patients’ pain was the same, better, or worse after their taper. They found that:

  • The included studies had patients with a wide range of pain conditions attending many different kinds of facilities
  • There was a wide variety in the types of tapers used
  • In some studies, the patients discontinued the opioids completely. In others, patients reduced their dose but continued to use opioids
  • 80% of the studies reported that patients’ pain improved following their opioid taper, and the rest reported that patients’ pain was the same. Only one study reported two patients whose pain was worse following their taper.
  • None of the included studies had a comparison group of patients who did not taper their opioids.

What kind of study was this?

This was a systematic review. A systematic review summarises all available studies on a health care intervention to provide high quality evidence on the effectiveness of that health care intervention.

Who participated in the study? This review included 20 studies that included 2109 patients with chronic pain conditions using or addicted to opioids.  

How was the study done? The reviewers included studies where patients underwent an opioid tapering procedure at a multidisciplinary facility, a pain facility, outpatient pain treatment clinics, medical hospitals or medical clinics, or addiction facilities or clinics. Pain levels had to be measured before and right after the taper was complete.

Opioid Taper

The types of opioid tapers differed but included: self-guided tapers with support from staff, gradually reducing the dose of opioid by 20-30%, immediate cessation with management of withdrawal symptoms, replacing the opioid with buprenorphine, and drug cocktails.  In some studies, the tapering procedure was not described.  

The opioid tapering lasted an average of 45 days, ranging from 2-180 days.

In many studies, patients received additional treatments during the taper. These included: counseling for addiction or pain; physical therapy, occupational therapy, cognitive behavioural counseling, and other drug therapies such as antidepressants.

Why was this research done?

Chronic pain is often treated with opioid medications. While these medications can provide pain relief, there is a risk of overdose, misuse, and abuse resulting from prescription opioids. Because of this, physicians have recently been advised not to use opioids to treat chronic pain. They have also been advised to help patients who are already using opioids to lower their doses, or stop using opioids altogether.

Many patients fear that their pain will increase if they try to lower their dose of opioids.  This fear can make it difficult for patients to go through a tapering process.

There are reasons to believe that patients’ pain will not increase if they lower their dose of opioids. Pain rehabilitation programs have typically had an opioid taper as part of their program. These programs have observed that most patients do not have increased pain after their taper. The authors of this study looked for all the published accounts of programs that have reported pain levels before and after an opioid dose reduction.

This Evidence Summary is based on the following article:

Fishbain DA, Pulikal A. Does Opioid Tapering in Chronic Pain Patients Result in Improved Pain or Same Pain vs Increased Pain at Taper Completion? A Structured Evidence-Based Systematic Review. Pain Med. 2018 Dec 28. pii: 5266432. doi: 10.1093/pm/pny231. PubMed

Published: Tuesday, February 26, 2019

Please note that the information contained herein is not to be interpreted as an alternative to medical advice from a professional healthcare provider. If you have any questions about any medical matter, you should consult your professional healthcare providers, and should never delay seeking medical advice, disregard medical advice or discontinue medication based on information provided here.