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Changes in pain intensity after discontinuation of long-term opioid therapy for chronic noncancer pain

McPherson, Sterlinga,b,c; Lederhos Smith, Crystala,b; Dobscha, Steven K.d,e; Morasco, Benjamin J.d,e; Demidenko, Michael I.d; Meath, Thomas H.A.d,f; Lovejoy, Travis I.d,e,g,*

doi: 10.1097/j.pain.0000000000001315
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Little is known about changes in pain intensity that may occur after discontinuation of long-term opioid therapy (LTOT). The objective of this study was to characterize pain intensity after opioid discontinuation over 12 months. This retrospective U.S. Department of Veterans Affairs (VA) administrative data study identified N = 551 patients nationally who discontinued LTOT. Data over 24 months (12 months before and after discontinuation) were abstracted from VA administrative records. Random-effects regression analyses examined changes in 0 to 10 pain numeric rating scale scores over time, whereas growth mixture models delineated pain trajectory subgroups. Mean estimated pain at the time of opioid discontinuation was 4.9. Changes in pain after discontinuation were characterized by slight but statistically nonsignificant declines in pain intensity over 12 months after discontinuation (B = −0.20, P = 0.14). Follow-up growth mixture models identified 4 pain trajectory classes characterized by the following postdiscontinuation pain levels: no pain (average pain at discontinuation = 0.37), mild clinically significant pain (average pain = 3.90), moderate clinically significant pain (average pain = 6.33), and severe clinically significant pain (average pain = 8.23). Similar to the overall sample, pain trajectories in each of the 4 classes were characterized by slight reductions in pain over time, with patients in the mild and moderate pain trajectory categories experiencing the greatest pain reductions after discontinuation (B = −0.11, P = 0.05 and B = −0.11, P = 0.04, respectively). Pain intensity after discontinuation of LTOT does not, on average, worsen for patients and may slightly improve, particularly for patients with mild-to-moderate pain at the time of discontinuation. Clinicians should consider these findings when discussing risks of opioid therapy and potential benefits of opioid taper with patients.

Pain intensity as assessed by numeric rating scale pain intensity scores did not significantly change in the 12 months after discontinuation of long-term opioid therapy.

aDepartment of Clinical Sciences, Elson S. Floyd College of Medicine, Washington State University, Spokane, WA, United States

bPrograms of Excellence in Addictions Research, Washington State University, Spokane, WA, United States

cProvidence Medical Research Center, Providence Health Care, Spokane, WA, United States

dCenter to Improve Veteran Involvement in Care, VA Portland Health Care System, Portland, OR, United States

eDepartment of Psychiatry, Oregon Health & Science University, Portland, OR, United States

fCenter for Health Systems Effectiveness, Oregon Health & Science University, Portland, OR, United States

gSchool of Public Health, Oregon Health & Science University Portland, OR, United States

Corresponding author. Address: VA Portland Health Care System, 3710 SW U.S. Veterans Hospital Rd, Mail Code: R&D 66, Portland, OR 97239, United States. Tel.: (503) 220-8262 x57744. E-mail address: travis.lovejoy@va.gov (T.I. Lovejoy).

Sponsorships or competing interests that may be relevant to content are disclosed at the end of this 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 Web site (www.painjournalonline.com).

Received December 08, 2017

Received in revised form May 21, 2018

Accepted May 23, 2018

© 2018 International Association for the Study of Pain
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