Patient Outcomes in Dose Reduction or Discontinuation of Long-Term Opioid Therapy

作者：Joseph W. Frank, Travis I. Lovejoy, William C. Becker, Benjamin J. Morasco, Christopher J. Koenig, Lilian Hoffecker, Hannah R. Dischinger, Steven K. Dobscha, Erin E. Krebs · 发表于：Annals of Internal Medicine · 年份：2017 · DOI：10.7326/m17-0598 · 被引用次数：320 · 研究领域：Opioid Use Disorder Treatment、Pain Management and Opioid Use、Pediatric Pain Management Techniques

BACKGROUND: Expert guidelines recommend reducing or discontinuing long-term opioid therapy (LTOT) when risks outweigh benefits, but evidence on the effect of dose reduction on patient outcomes has not been systematically reviewed. PURPOSE: To synthesize studies of the effectiveness of strategies to reduce or discontinue LTOT and patient outcomes after dose reduction among adults prescribed LTOT for chronic pain. DATA SOURCES: MEDLINE, EMBASE, PsycINFO, CINAHL, and the Cochrane Library from inception through April 2017; reference lists; and expert contacts. STUDY SELECTION: Original research published in English that addressed dose reduction or discontinuation of LTOT for chronic pain. DATA EXTRACTION: Two independent reviewers extracted data and assessed study quality using the U.S. Preventive Services Task Force quality rating criteria. All authors assessed evidence quality using the GRADE (Grading of Recommendations Assessment, Development and Evaluation) system. Prespecified patient outcomes were pain severity, function, quality of life, opioid withdrawal symptoms, substance use, and adverse events. DATA SYNTHESIS: Sixty-seven studies (11 randomized trials and 56 observational studies) examining 8 intervention categories, including interdisciplinary pain programs, buprenorphine-assisted dose reduction, and behavioral interventions, were found. Study quality was good for 3 studies, fair for 13 studies, and poor for 51 studies. Many studies reported dose reduction, but rates...