Table 1.
Characteristics of 19 Prioritized Studies
| Author, Year N, Study Design |
Setting Follow-up |
Patient Age (mean) % Male % White |
Most common pain type | Chronic pain (yrs.) | LTOT (yrs.) | Mean MEDD: Base/ % Discont. |
Intervention | Taper schedule | Taper speed |
|---|---|---|---|---|---|---|---|---|---|
| RCTs | |||||||||
|
Kurita, 2018*50 35 RCT |
Multidisciplinary Pain Centre University Hospital, Denmark 6 mos. |
53 yrs. 40% male Race NR |
Neuropathic and nociceptive somatic pain (49.3%) |
>6 mos. | >3 mos. | 280mg/ 227mg | Voluntary or patient-initiated; opioid dose stabilization followed by taper vs usual care | Dose reduction 10% every 1-2 weeks | Slow |
|
Sullivan, 201764 35 RCT |
UW Medicine Center for Pain Relief 22 weeks |
54 yrs. 29% male 85.7% white |
NR | 13.8 yrs. | 10.2 yrs. |
226mg 37% decreased dose |
Voluntary; CBT and self-management skills building vs usual care | 10% reduction per week | Slow |
| Controlled Studies | |||||||||
|
Demidenko, 2017*56 509 Case-control |
VHA national sample 12 mos. |
55 yrs. 94.3% male 70.7% white | MSK (85.1%) | NR | NR |
76mg 100% discont. |
85% clinician-initiated; no specific intervention | NR | NR |
|
DiBenedetto, 201960* 778 Retrospective cohort |
Community pain management practice Unclear |
53.2 yrs. 45.2% male Race NR |
Mixed/ central | NR | ≥ 3 mos. |
125.1mg 31.2% dose decrease |
No specific intervention | NR | NR |
|
James, 2019*61 572 Case-control |
Academic primary care clinic |
54.9 yrs. 54.4% male 52.3% white |
NR | NR | NR |
25.3%:120-359mg 10.7%: ≥ 360mg 60.1% discont. |
No specific intervention | NR | NR |
|
Nicholas, 201963* 140 Case-control |
Outpatient pain management clinic 12 mos. |
43 yrs. 47% male Race NR |
Lower back | 6 yrs | NR |
47.1mg 72.5% discont. |
Voluntary, 3-week outpatient pain management program with opioid discontinuation | Individualized | NR |
|
Perez, 2019*62 1,624 Case-control |
Academic healthcare system 3 yrs. |
51.5 yrs. 45.8% male 16.4% white |
Back pain (63%); extremity pain (63%) | NR | NR |
90 mg 12.7% with taper |
No specific intervention | NR | NR |
|
Von Korff, 2019*54 31,142 Retrospective cohort |
Group Health system, Washington 8 yrs. |
Age NR Sex NR Race NR |
NR | NR | NR |
76mg/ 40mg |
Clinician-initiated; no specific intervention | NR | NR |
| Uncontrolled Studies | |||||||||
|
Darchuk, 201027 292 Pre-post |
Mayo Clinic Pain Rehabilitation Center 6 mos. |
45.8 yrs. 21.4% male 95.3% white |
Low back pain (24.5%) | 10.7 yrs. | NR |
112mg 94% discont. |
Voluntary; 3-week intensive outpatient program | Individualized | Fast |
|
Darnall, 2018*55 82 Pre-post |
Community pain clinics, California 4 mos. |
51 yrs. 40% male Race NR | NR | NR | 6 yrs. | 288mg/ 150mg | Voluntary; use of self-help book | Individualized; up to 5% in month 1, up to 10% per week in mos. 2-4 | Slow |
|
Harden, 201530 50 Pre-post |
Philadelphia VA Medical Center 12 mos. |
54 yrs. 88% male 60% white |
Back (35%) | NR | 12 mos. |
>200mg (64%) 94% decreased dose |
Clinician-initiated with patient consent; no specific intervention | Individualized | Slow |
|
Hooten, 2007b33 66 Pre-post |
Mayo Clinic Pain Rehabilitation Center 3 weeks |
46.8 yrs. 50% male 90.6% white |
Fibromyalgia (100%) |
Men: 11.3 yrs.; Women 9.5 yrs. |
NR |
Men: 64mg, Women: 39 mg 95% discont. |
Voluntary; 3-week intensive outpatient program | Individualized | Fast |
|
Hooten, 200932 1241 Pre-post |
Mayo Clinic Pain Rehabilitation Center 3 weeks |
46.5 yrs. 25.2% male 94.9% white |
Low back (27%) | 9.9 yrs. | NR |
118mg 96% discont. |
Voluntary; 3-week intensive outpatient program | Individualized | Fast |
|
Huffman, 201736 1457 Pre-post |
Cleveland Clinic Pain Rehabilitation Outpatient Program 12 mos. |
46.3 yrs. 35.6% male Race: NR |
NR | NR | >3 mos. |
117mg 87% discont. |
Voluntary or patient-initiated; 3-4 week intensive outpatient program | Individualized | Fast |
|
Hundley, 2018*57 43 Pre-post |
North Florida/South Georgia Veterans Health System 5 yrs. |
61 yrs. 95.3% male 83.7% White | NR | NR | 7.8 yrs. |
330mg 65% discont. |
Mandated; no specific intervention | Individualized | Slow |
|
Mark, 2019*59 494 Uncontrolled cohort |
Medicaid beneficiaries in Vermont 90 days |
47 yrs. 51% male Race NR |
NR | NR | Mean 613 days |
≥120 mg 100% discont. |
No specific intervention |
86% < 21 days 9% 21 to < 90 days 5% ≥ 90 days |
Varied |
|
McPherson, 2018*58 551 Pre-post |
VHA national sample 24 mos. |
54.6 yrs. 95% male 71% white | MSK (87%) | NR | NR |
76mg 100% discont. |
85% clinician-initiated; no specific intervention | NR | NR |
|
Murphy, 201340 705 Pre-post |
VHA Chronic Pain Rehabilitation Program, Florida 3 weeks |
49.08 yrs. 82.4% male 66.1 white |
Back (60.2%) | 12.69 yrs. | NR |
61mg 100% discont. |
Voluntary; 3-week inpatient intensive multidisciplinary program | Individualized | Fast |
|
Townsend, 200846 373 Pre-post |
Mayo Clinic Pain Rehabilitation Center 6 mos. |
44.5 yrs. 20.9% male 95.7% white |
Low back (24.4%) | 9.4 yrs. | 3.9 yrs. |
99mg 93% discont. |
Voluntary; 3-week intensive outpatient program | Individualized | Fast |
*New since Frank 2017
MEDD morphine equivalent daily dose, Discont. discontinued, LTOT long-term opioid therapy, Fast taper < 1 month; Slow taper > 1 month; NR not reported, yrs. years, mos. months; MSK musculoskeletal, NCM nurse care management, CBT cognitive behavioral therapy