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Changes Ii Pain Intensity Following Discontinuation of Long-Term Opioid Therapy for Chronic Non-Cancer Pain

McPherson, Sterling, PhD1-3; Smith, Crystal Lederhos, MS1,2; Dobscha, Steven K., MD4,5; Morasco, Benjamin J., PhD4,5; Demidenko, Michael I., BS4; Meath, Thomas H. A., MPH4,6; Lovejoy, Travis I., PhD, MPH4,5,7,*

doi: 10.1097/j.pain.0000000000001315
Research Paper: PDF Only

Little is known about changes in pain intensity that may occur following discontinuation of long-term opioid therapy (LTOT). The objective of this study was to characterize pain intensity following opioid discontinuation over 12 months. This retrospective VA administrative data study identified N=551 patients nationally who discontinued LTOT. Data over 24 months (12 months prior to and following discontinuation) were abstracted from VA administrative records. Random effects regression analyses examined changes in 0-10 pain numeric rating scale scores over time, while growth mixture models delineated pain trajectory sub-groups. Mean estimated pain at the time of opioid discontinuation was 4.9. Changes in pain following discontinuation were characterized by slight but statistically non-significant declines in pain intensity over 12 months post-discontinuation (B=-0.20, p=0.14). Follow-up growth mixture models identified four pain trajectory classes characterized by the following post-discontinuation 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 four 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 post-discontinuation (B=-0.11, p=0.05 and B=-0.11, p=0.04, respectively). Pain intensity following 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.

1 Department of Clinical Sciences, Washington State University Elson S. Floyd College of Medicine

2 Programs of Excellence in Addictions Research, Washington State University

3 Providence Medical Research Center, Providence Health Care

4 Center to Improve Veteran Involvement in Care, VA Portland Health Care System

5 Department of Psychiatry, Oregon Health & Science University

6 Center for Health Systems Effectiveness, Oregon Health & Science University

7 School of Public Health, Oregon Health & Science University

Corresponding author: Travis I. Lovejoy, PhD, MPH, VA Portland Health Care System, 3710 SW U.S. Veterans Hospital Road, Mail Code: R&D 66, Portland, OR 97239, U.S.A.; Phone: (503) 220-8262 x57744; Email: travis.lovejoy@va.gov.

Correspondence: Travis I. Lovejoy, PhD, MPH, VA Portland Health Care System, 3710 SW U.S. Veterans Hospital Road, Portland, OR 97239, Email: travis.lovejoy@va.gov, Phone: (503) 220-8262 x57744

Conflict of Interest Statement

Dr. Lovejoy reports grants from the U.S. Department of Veterans Affairs Health Services Research & Development during the conduct of the study. Dr. McPherson has received research funding from Ringful Health, Consistent Care, and the Orthopedic Specialty Institute. The authors report no other conflicts of interest.

© 2018 International Association for the Study of Pain
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