Intensity of Withdrawal Symptoms During Opioid Taper in Patients with Chronic Pain—Individualized or Fixed Starting Dosage?

Abstract Objective Controlled opioid withdrawal is recommended for patients with chronic noncancer pain (CNCP) with insufficient pain reduction or intolerable side effects while on opioid treatment. Few studies have investigated the management of opioid withdrawal (OW). Most common are protocols wit...

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Bibliographic Details
Published in:Pain medicine (Malden, Mass.) Mass.), 2019-12, Vol.20 (12), p.2438-2449
Main Authors: Bienek, Natalia, Maier, Christoph, Kaisler, Miriam, Michel-Lauter, Beate, Schwarzer, Andreas, Meyer-Frießem, Christine H
Format: Article
Language:English
Subjects:
Care and treatment
Chi-square test
Chronic pain
Complications and side effects
Development and progression
Dosage
Drug therapy
Drug withdrawal
Drug withdrawal symptoms
Morphine
Narcotics
Opioids
Overdose
Pain
Pain management
Patient safety
Statistical analysis
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Summary:Abstract Objective Controlled opioid withdrawal is recommended for patients with chronic noncancer pain (CNCP) with insufficient pain reduction or intolerable side effects while on opioid treatment. Few studies have investigated the management of opioid withdrawal (OW). Most common are protocols with an individualized starting dosage (ISD), calculated from the last opioid intake. After two cases of overdose, we introduced a novel withdrawal protocol using a low fixed starting dosage (FSD) for safety reasons. The present study compares the intensity of withdrawal symptoms using the Subjective Opioid Withdrawal Scale (SOWS) and incidences of serious adverse events (SAE) and dropouts in each taper schedule in 195 CNCP patients with OW in an inpatient facility. Methods Two protocols were compared: FSD (2014–2016): N = 68, starting dose: 90 mg morphine/d; and ISD (2010–2014): N = 127, starting dose: 70% of the patient’s daily morphine equivalent dose (MED). Outcome criteria: primary: mean daily SOWS score during the first 10 days (16 questions, daily score 0–64); secondary: change in pain intensity on a numeric rating scale (0–10), rate of dropouts and SAEs. Statistics: Student test, Mann-Whitney U test, chi-square test, analysis of variance, P 
ISSN:1526-2375
1526-4637
DOI:10.1093/pm/pny320