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Opioid Reduction Following Interventional Procedures for Chronic Pain: A Synthesis of the Evidence

Maher, Dermot P. MD*; Cohen, Steven P. MD*†‡

doi: 10.1213/ANE.0000000000002276
Chronic Pain Medicine: Narrative Review Article

The past decade has witnessed the tremendous growth of procedures to treat chronic pain, which has resulted in increased third-party scrutiny. Although most of these procedures appear to be associated with significant pain relief, at least in the short and intermediate term, their ability to improve secondary outcome measures, including function and work status is less clear-cut. One of these secondary outcome measures that has garnered substantial interest in the pain and general medical communities is whether interventions can reduce opioid intake, which is associated with significant risks that in most cases outweigh the benefits in the long term. In the article, we examine whether procedural interventions for chronic pain can reduce opioid intake. Most studies that have examined analgesic reduction as a secondary outcome measure have not separated opioid and nonopioid analgesics, and, among those studies that have, few have demonstrated between-group differences. Reasons for failure to demonstrate opioid reduction can be broadly classified into procedural, design-related, clinical, psychosocial, biological, and pharmacological categories, all of which are discussed. In the future, clinical trials in which this outcome is examined should be designed to evaluate this, at least on a preliminary basis.

Supplemental Digital Content is available in the text.Published ahead of print July 14, 2017.

From the *Department of Anesthesiology & Critical Care Medicine and Departments of Anesthesiology & Critical Care Medicine, Neurology, and Physical Medicine & Rehabilitation, Johns Hopkins School of Medicine, Bethesda, Maryland; and Departments of Anesthesiology and Physical Medicine & Rehabilitation, Uniformed Services University of the Health Sciences, Bethesda, Maryland.

Accepted for publication May 11, 2017.

Published ahead of print July 14, 2017.

Funding: Funded in part by the Centers for Rehabilitation Sciences Research, Bethesda, MD.

Conflicts of Interest: See Disclosures at the end of the article.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s website.

Reprints will not be available from the authors.

Address correspondence to Steven P. Cohen, MD, Department of Anesthesiology & Critical Care Medicine, Johns Hopkins School of Medicine, 550 N Broadway, Suite 301, Baltimore, MD 21205. Address e-mail to

© 2017 International Anesthesia Research Society
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