To Taper or not to Taper, that is not the question: how to taper very much is

Spine & Nerve

In this week's episode of the Spine & Nerve podcast Dr. Nicolas Karvelas and Dr. Brian Joves highlight a patient centered approach to tapering opioids. Treatment of the chronic pain disease process is challenging, but optimizing patient buy in and creating an active participant in the treatment plan can be very powerful. In many clinical scenarios the goal of tapering / minimizing opioids is medically appropriate to optimize patient safety and health, as well as improve the patient’s function and pain severity. The tapering of opioids can be very difficult and challenging for the patient and the healthcare provider for a multitude of reasons. With an intensive regimented opioid reduction program (although indicated in some scenarios, especially when significant aberrancy is identified) there is some level of concern for potential negative clinical outcomes. These include, but are not limited to, relatively high rate of relapse to utilization of opioids (up to 30%), as well as concern for increased risk for suicide after the taper (Hazard Ratios as high as 6.77 for patients on long term opioids). The importance of these statements is absolutely not to suggest that opioids should typically be continued for chronic non-cancer pain, but rather to emphasize that the method utilized to achieve the taper is critical. Listen as the doctors discuss this difficult medical challenge, including a recent study by Dr. Ziadni and colleagues that demonstrates that a patient centered approach to the opioid taper leads to stable and significant opioid reduction with overall improvement in pain as well. As stated this emphasizes an overall broader and important concept that the active participation of the patient in the treatment plan can result in improved and more sustainable health benefits. This podcast is for information and educational purposes only, it is not meant to be medical or career advice. If anything discussed may pertain to you, please seek council with your healthcare provider. The views expressed are those of the individuals expressing them, the may not represent the views of Spine & Nerve. References: 1. Ziadni, Maisaa; Chen, Abby L.; Krishnamurthy, Parthasarathy; Flood, Pamela; Stieg, Richard L; Darnall, Beth D. Patient-centered prescription opioid tapering in community outpatients with chronic pain: 2- to 3-year follow-up in a subset of patients, PAIN Reports: September/October 2020 - Volume 5 - Issue 5 - p e851. 2. Huffman KL, Rush TE, Fan Y, Sweis GW, Vij B, Covington EC, Scheman J, Matthews M. Sustained improvements in pain, mood, function and opioid use post interdisciplinary pain rehabilitation in patients weaned from high and low dose chronic opioid therapy. PAIN 2017;18:308–18. 3. Oliva E, Bowe T, Manhapra A, Kertesz S, Hah JM, Henderson P, Robinson A, Paik M, Sandbrink F, Gordon AJ, Trafton JA. Associations between stopping prescriptions for opioids, length of opioid treatment, and overdose or suicide deaths in US veterans: observational evaluation. BMJ 2020;368:m283.