A recent research has suggested that if one is on a long-term prescription of opioid medication, tapering the dose can help in improving pain and function and will also boost the quality of life. So, in this case, less is actually better for you.
Dr. Joseph Frank, a primary care physician at Denver’s Veterans Affairs Medical Center and the lead author of the new study said that almost 10 million Americans resort to long-term opioid medications in order to manage chronic pain. Oxycodone (Oxycontin, Percocet) and hydrocodone (Vicoprofen) are all included in Opioid medications. Doctors prescribe these medications over extended periods in order to treat a variety of chronic pain conditions, like arthritis or low back pain.
Frank remarked that there are ongoing nationwide efforts to reduce the usage of opioid drugs. Such efforts will have an impact people who have been prescribed these drugs for long term use for chronic pain management. But, there is not much known about the benefits and risks associated with reducing long-term opioid therapy. If a person has been taking them for a long time and then stops suddenly, it is likely that he will suffer from unpleasant withdrawal symptoms.
The report on this research was published online recently in the Annals of Internal Medicine.
Tamara Haegerich, of the U.S. Centers for Disease Control and Prevention, added that the withdrawal symptom when opioids are reduced or discontinued too quickly for people who were using them over prolonged period include drug craving, anxiety, insomnia, abdominal pain, and tremor. She added that one size fits all approach will not apply here and there be a need to customize the tapered dose according to patient goals and concerns.
As a part of their research review, Frank and his fellow colleague analyzed 67 studies that focussed on reducing or discontinuing opioid therapy prescribed for chronic pain management. About 40 of these studies specifically delved into how people fared when the dose of the opioid medication was reduced. The good news is that most people reported having found some improvement in pain severity, function, and quality of life.
However, the quality of evidence in the studies was not very high. The researchers still emphasized on the need of cutting back on opioid medication. There are several important risks associated with opioid medication like addiction and overdose. Also, there are other problems like an increased risk of fractures, heart attack, sleep issues, mood swings, and libido problems associated with it.
The risks increase with an increase in dose. One remedy is to taper the doses or stopping them altogether. But, that too is not devoid of issues as it can lead to illegal substance use or even suicide. So, ideally, the tapering of opioid dose should be gradual and should be supported by other non-opioid care.
Mindfulness meditation and cognitive behavioral therapy, a type of psychotherapy are some of the non-opioid treatment that might be needed.
Dr. Harshal Kirane, Director of addiction services at Staten Island University Hospital in New York City remarked that identifying effective non-opioid approaches to chronic pain management is of significant importance. Kirane is not a part of the research team but added that medication-assisted therapies which involve agents such as methadone and buprenorphine can also help opioid tapering.
Among the various ways tapering of opioid dose can be done, the basic is to lower a patient’s daily dose by 10 percent every five to seven days explained Kirane. This need to be done until the patient is off the medication completely, or re-establishes a lower baseline regimen. Abruptly stopping opioids is likely to give withdrawal syndromes or will make the person highly vulnerable to relapse back to opioid use.
Opioid prescribing has widely occurred without an adequate risk assessment in the last two decades. Kirane added that by aiding individuals to develop healthy skills and habits to deal with chronic pain, the opioid epidemic can be handled.