Opioids for chronic pain: To wean or not to wean

Considerable controversy remains regarding the use of opioids for treatment of non-malignant chronic pain. Traditional multidisciplinary pain treatments have historically weaned patients from opioid medications and focused treatment on restoring function, decreasing negative affect, and promoting adaptive coping. In this study we examined patients who entered a multidisciplinary pain treatment program who were weaned from opioids vs. those who were not weaned from opioids. Treatment outcome for the two groups was assessed across three domains: pain intensity, negative affect, and general activity/function. A total of 194 patients from a multidisciplinary pain rehabilitation program were recruited: opioid wean (N=89) and non-wean (N=105). Both groups underwent the same treatment comprised of physical therapy, and group and individual Cognitive Behavioral Treatment. Both groups were assessed at enrollment in the program and at completion of the program with a number of standardized assessment instruments. Results indicated that both groups showed highly reliable treatment changes in pain intensity (p < .001, eta2 = .36), activity level (p < .001, eta2= .17), and negative mood (p < .001, eta2 = .52). No group by treatment interactions approached significance for any of the treatment measures. These results appear to indicate that weaning chronic pain patients from opioids had no deleterious effects on traditional treatment outcomes. Furthermore, there was no evidence that terminating opioid therapy resulted in opioid hyperalgesia. In fact, those weaned from opioids experienced the same decrease in pain from treatment as individuals not weaned, or not taking opioids. Examination of residualized change scores (change in morphine equivalent vs. change in pain) for the opioid wean group showed no reliable relationship between amount of opioid decrease and amount of pain decrease. Results support the efficacy of multidisciplinary, rehabilitation focused treatment of chronic pain, in both opioid and non-opioid treated patients.