Table 3.
Certainty of evidence and summary effect estimates assessed by GRADE (grading of recommendations, assessment, development, and evaluation) of controlled trials investigating interventions to taper long term opioid treatment for non-cancer chronic pain
| Outcome | Intervention group | ||||
|---|---|---|---|---|---|
| Pain self-management | Complementary and alternative medicine | Pharmacological and biomedical devices and interventions | Opioid replacement treatment | Deprescription | |
| Opioid discontinuation (positive effect favours intervention over control) |
Very low certainty (RR 2.15 (95% CI 1.02 to 4.53), τ2=0.00, I2=0%); subgroup: pain self-management v no pain self-management | Very low certainty (moderate positive effect) | Very low certainty (RR 6.07 (95% CI 1.16 to 31.77), τ2=0.00, I2=0%); subgroup: SCS v conventional medical treatment | Low certainty (no effect) | Low certainty (no effect); subgroup: patient focused |
| Low certainty (nil or small positive effect); subgroup: other | — | Low certainty (nil or moderate positive effect); subgroup: other | — | Moderate certainty (aOR 1.5 (95% CI 1.0 to 2.1)*); subgroup: prescriber focused | |
| Opioid dose (negative effect favours intervention over control) | Moderate certainty (MD −14.31 mg daily OME (95% CI −21.57 to−7.05), τ2=0.00, I2=0%); subgroup: pain self-management v no pain self-management | Very low certainty (MD −1.56 mg daily OME (95% CI −19.03 to 15.92), τ2=155.05, I2=69%); subgroup: acupuncture v no acupuncture | Low certainty (nil or small negative effect) | Very low certainty (no effect) | Low certainty (no effect); subgroup: patient focused |
| Low certainty (small negative effect); subgroup: other | Very low certainty (moderate negative effect); subgroup: other | — | — | Moderate certainty (MD −6.8 (SE 1.6) mg daily OME*); subgroup: prescriber focused | |
| Pain intensity (negative effect favours intervention over control) | Low certainty (SMD −0.59 (95% CI −1.02 to −0.16), τ2=0.00, I2=0%); subgroup: pain self-management v no pain self-management | Very low certainty (SMD 0.02 (95% CI −0.29 to 0.34), τ2=0.00, I2=0%); subgroup: acupuncture v no acupuncture | Low certainty (nil or small negative effect) | Very low certainty (no effect) | Low certainty (nil or small positive effect); subgroup: patient focused |
| Low certainty (small negative effect); subgroup: other | — | — | — | — | |
| Pain related function (negative effect favours intervention over control) | Low certainty (SMD –0.27 (95% CI –0.69 to 0.15), τ2=0.00, I2=0%); subgroup: pain self-management v no pain self-management | Low certainty (no effect) | Low certainty (nil or small negative effect) | Very low certainty (no effect) | Low certainty (nil or small positive effect) subgroup: patient focused |
| Low certainty (small negative effect); subgroup: other | — | — | — | — | |
| Quality of life (positive effect favours intervention over control) | Very low certainty (small positive effect) | Low certainty (no effect) | Low certainty (nil or small positive effect) | — | Very low certainty (no effect); subgroup: patient focused |
| Withdrawal symptoms (negative effect favours intervention over control) | — | Very low certainty (no effect) | Low certainty (no effect) | Low certainty (no effect) | Low certainty (small positive or negative effect); subgroup: patient focused |
| Substance use (negative effect favours intervention over control) | Low certainty (no effect) | — | — | Very low certainty (multiple events†) | Low certainty (no effect); subgroup: patient focused |
| Adverse events (negative effect favours intervention over control) | Low certainty (1 event†) | Low certainty (few minor events†) | Low certainty (multiple events†) | Low certainty (multiple events†) | Low certainty (no effect); subgroup: patient focused |
aOR=adjusted odds ratio; MD=mean difference; OME=oral morphine equivalent; RR=risk ratio; SCS=spinal cord stimulation; SE=standard error; SMD=standardised mean difference.
*
Statistics were the findings from one study of 985 participants.
†
Differences between intervention and control groups on this outcome were not reported in this group of studies.