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Deprescribing opioids in chronic non-cancer pain : systematic review of randomised trials
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Mathieson, Stephanie, Maher, Christopher G., Ferreira, Giovanni E., Hamilton, Melanie, Jansen, Jesse, McLachlan, Andrew J., Underwood, Martin and Chung-Wei, Christine Lin (2020) Deprescribing opioids in chronic non-cancer pain : systematic review of randomised trials. Drugs, 80 . pp. 1563-1576. doi:10.1007/s40265-020-01368-y ISSN 0012-6667.
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WRAP-deprescribing-opioids-chronic-non-cancer-pain-systematic-review-randomised-trials-Underwood-2020.pdf - Accepted Version - Requires a PDF viewer. Download (1904Kb) | Preview |
Official URL: https://doi.org/10.1007/s40265-020-01368-y
Abstract
Background
Deprescribing, the process of reducing or discontinuing unnecessary or harmful medicines is an essential part of clinical practice.
Objective
To evaluate the efficacy of interventions designed to deprescribe opioid analgesics for pain relief in patients with chronic non-cancer pain.
Methods
We searched electronic databases, including clinical trial registries, from database inception to 13th January 2020 without restrictions, and conducted citation tracking. Our systematic review included randomised controlled trials (RCTs) evaluating interventions reducing the prescription, or use of opioid analgesics in patients with chronic pain versus control. Inventions could be aimed at the patient, clinician, or both. We excluded trials enrolling patients with cancer or illicit drug use. Two authors independently screened and extracted data. Outcome follow-up timepoints were short (≤ 3 months), intermediate (> 3 but < 12 months) or long (≥ 12 months) term. Primary outcome was the reduction in opioid dose [morphine milligram equivalent (MME) mg/day]. Methodological quality was assessed using the Cochrane Risk of Bias Tool.
Results
We included ten patient-focused RCT interventions (n = 835; median 37 participants) and 2 testing clinician-focused interventions (n = 291 clinicians); none at low risk of bias. Patient-focused interventions did not reduce opioid dose in the intermediate term [e.g. dose reduction protocol, mean difference (MD) − 19.9 MME, 95% CI − 107.5 to 67.7], nor did they increase the number of participants who ceased their dose, or increase the risk of serious adverse events or adverse events. One clinician intervention of education plus decision tools versus decision tools alone reduced the number of opioid prescriptions (risk difference (RD) − 0.1, 95% CI − 0.2 to − 0.1), dose (MD − 5.3 MME, 95% CI − 6.2 to − 4.5) and use (RD − 0.1, 95% CI − 0.1 to − 0.0) in the long term.
| Item Type: | Journal Article | |||||||||
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| Subjects: | R Medicine > RB Pathology | |||||||||
| Divisions: | Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School > Clinical Trials Unit Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School > Health Sciences Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School |
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| Library of Congress Subject Headings (LCSH): | Chronic pain, Chronic pain -- Treatment, Opioids -- Therapeutic use, Narcotics -- Therapeutic use, Pain -- Chemotherapy | |||||||||
| Journal or Publication Title: | Drugs | |||||||||
| Publisher: | Springer | |||||||||
| ISSN: | 0012-6667 | |||||||||
| Official Date: | October 2020 | |||||||||
| Dates: |
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| Volume: | 80 | |||||||||
| Page Range: | pp. 1563-1576 | |||||||||
| DOI: | 10.1007/s40265-020-01368-y | |||||||||
| Status: | Peer Reviewed | |||||||||
| Publication Status: | Published | |||||||||
| Reuse Statement (publisher, data, author rights): | This is a post-peer-review, pre-copyedit version of an article published in Drugs. The final authenticated version is available online at: http://dx.doi.org/10.1007/s40265-020-01368-y | |||||||||
| Access rights to Published version: | Restricted or Subscription Access | |||||||||
| Date of first compliant deposit: | 20 July 2020 | |||||||||
| Date of first compliant Open Access: | 31 July 2021 | |||||||||
| RIOXX Funder/Project Grant: |
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