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A new study has found a lack of consensus among medical experts on whether long-term opioid therapy should be continued or discontinued for patients with chronic pain. The findings highlight the complexity of chronic pain management and the challenges faced by clinicians in prescribing opioid medications.
Published in the journal Pain Practice, the study titled “Management of patients at risk of harms from both continuing and discontinuing their long-term opioid therapy: A qualitative study to inform the gap in clinical practice guidelines” analyzed the perspectives of 28 medical experts on the potential benefits and harms of maintaining, tapering, or terminating opioid prescriptions for patients suffering from non-cancer chronic pain lasting three or more months.
A Divided Perspective
The study revealed that experts were split on the issue. Approximately 36% of the experts supported long-term opioid therapy, while an equal percentage advocated for discontinuation. Meanwhile, more than half of the respondents cautioned against rapid tapering or discontinuation, warning that such an approach could lead to withdrawal symptoms, worsening pain, mental health complications, and even an increased risk of overdose and death.
Some experts suggested a gradual tapering process, even if prior attempts had failed, and recommended integrating other medications to mitigate withdrawal symptoms. Others proposed transitioning patients to buprenorphine, a drug that reduces dependency effects such as withdrawal and cravings while still addressing pain. Additionally, experts suggested that non-opioid pain treatments should be revisited, even if they had not been effective in the past, with a focus on shared decision-making between patient and provider.
Addressing Co-Occurring Conditions
Some experts emphasized the importance of managing co-occurring conditions such as mental health disorders, alcohol use, and opioid-related side effects. However, few addressed the need to assess or manage opioid use disorder or the risks associated with overdose.
Dr. Kurt Kroenke, a co-author of the study from the Regenstrief Institute and the Indiana University School of Medicine, acknowledged the delicate balance clinicians must maintain. “The potential harms of opioid pain medication are well known. Nevertheless, patients can become habituated to them and want their physicians to continue prescribing them. Taking patients off opioids may result in return or worsening of chronic pain, mental health issues, drug-seeking behavior, and potentially overdose and death. Additionally, these drugs could be used by someone else, possibly winding up on the street.”
At the same time, Dr. Kroenke pointed out that opioid pain medications do provide relief for some individuals, enabling them to engage in daily activities such as working, socializing, and spending time with family.
The Need for Balanced Guidelines
The study authors conclude that clinical guidelines should take into account multiple factors, including provider liability concerns, evolving regulations, healthcare system policies, and differing patient-provider perspectives. They recommend that care decisions be based on ethical medical practices, emphasizing informed consent and mutual respect between clinicians and patients.
Disclaimer: This article is for informational purposes only and does not constitute medical advice. Patients should consult their healthcare provider before making any changes to their medication or pain management regimen.
