Longitudinal Observation of Changes in Pain Sensitivity during Opioid Tapering in Patients with Chronic Low-Back Pain

Wang, Haili; Akbar, Michael; Weinsheimer, Nina; Gantz, Simone; Schiltenwolf, Marcus

doi:10.1111/j.1526-4637.2011.01276.x

Cited by 38 publications

(19 citation statements)

References 30 publications

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“…139 Also, in preclinical models, opioid withdrawal induces central changes in neurotransmitters, along with neuroimmune and neuroinflammatory mediators involved in nociception, 43,44 thus potentially intensifying pain beyond OIH. A general increase in pain sensitivity after opioid cessation can occur after acute 4,55 or chronic 66,109,132,144 opioid exposure, referred to by a variety of names including withdrawal-induced hyperalgesia (WIH). For individuals with chronic noncancer pain (CNCP) or an opioid use disorder (OUD), severity of pain during and immediately after opioid withdrawal can be a risk factor for restarting opioids.…”

Section: Introductionmentioning

confidence: 99%

Withdrawal-associated injury site pain (WISP): a descriptive case series of an opioid cessation phenomenon

Rieb

Norman

Martin

et al. 2016

PAIN

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Section: Introductionmentioning

confidence: 99%

Withdrawal-associated injury site pain (WISP): a descriptive case series of an opioid cessation phenomenon

Rieb

Norman

Martin

et al. 2016

PAIN

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“…(22–24) Furthermore, normalization of hyperalgesia has been demonstrated in patients tapered off opioids after 6 months. (25) Thus, reduction of persistent opioid use may reduce a multitude of adverse effects. Of great importance, there is an association between long-term prescription opioid use, affective disorders and substance abuse.…”

Section: Introductionmentioning

confidence: 99%

Self-Loathing Aspects of Depression Reduce Postoperative Opioid Cessation Rate

Hah

Mackey

Barelka³

et al. 2014

Pain Med

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Objective We previously reported that increased preoperative Beck Depression Inventory II (BDI-II) scores were associated with a 47% (95% CI 24%–64%) reduction in the rate of opioid cessation following surgery. (1) We aimed to identify the underlying factors of the BDI-II (affective/cognitive vs. somatic) associated with a decreased rate of opioid cessation after surgery. Methods We conducted a secondary analysis of the data from a previously reported (1) prospective, longitudinal, observational study of opioid use after 5 distinct surgical procedures (total hip replacement, total knee replacement, thoracotomy, mastectomy, and lumpectomy) in 107 patients. The primary endpoint was time to opioid cessation. After exploratory factor analysis of the BDI-II, mean summary scores were calculated for each identified factor. These scores were evaluated as predictors of time to opioid cessation using Cox proportional hazards regression. Results The exploratory factor analysis produced three factors (self-loathing symptoms, motivational symptoms, emotional symptoms). All three factors were significant predictors in univariate analysis. Of the three identified factors of the BDI-II, only preoperative self-loathing symptoms (past failure, guilty feelings, self-dislike, self-criticalness, suicidal thoughts, worthlessness) independently predicted a significant decrease in opioid cessation rate after surgery in the multivariate analysis (HR 0.86, 95% CI 0.75–0.99, p-value 0.037). Conclusions Our results identify a set of negative cognitions predicting prolonged time to postoperative opioid cessation. Somatic symptoms captured by the BDI-II were not primarily responsible for the association between preoperative BDI-II scores and postoperative prolonged opioid use.

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“…45,46 Experimental pain testing protocols suggest that sensory hyperalgesia may appear immediately after discontinuation of long-term opioid treatment. [47][48][49] Similar hyperalgesia has been described postoperatively, when the use of short-acting opioids is abruptly discontinued at the end of surgery. 50 In light of the functional improvement and pain reduction typically reported after discontinuation of longterm opioid treatment, [39][40][41][42][43][44][45][46] hyperalgesia appears to be a brief, time-limited phenomenon.…”

Section: Central Issues During Tapering Of Long-term Opioid Treatmentmentioning

confidence: 94%

“…Convincing evidence (from an aggregated population of 1520 patients) [39][40][41][42][43][44][45][46] suggests stable or improved pain reports after an opioid taper, although short-term withdrawal can lead to transitory increased pain and hyperalgesia. [47][48][49] Continued pain management, including optimized nonopioid regimens and interventional approaches, should be offered (recommendation GRADE D). In parallel, teaching patients about expected pain outcomes might provide reassurance and would be the topic of an interesting study.…”

Section: Recommendationsmentioning

confidence: 99%

Tapering Long-term Opioid Therapy in Chronic Noncancer Pain

Berna

Kulich

Rathmell

2015

Mayo Clinic Proceedings

187

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Increasing concern about the risks and limited evidence supporting the therapeutic benefit of long-term opioid therapy for chronic noncancer pain are leading prescribers to consider discontinuing the use of opioids. In addition to overt addiction or diversion, the presence of adverse effects, diminishing analgesia, reduced function and quality of life, or the absence of progress toward functional goals can justify an attempt at weaning patients from long-term opioid therapy. However, discontinuing opioid therapy is often hindered by patients' psychiatric comorbidities and poor coping skills, as well as the lack of formal guidelines for the prescribers. The aim of this article is to review the existing literature and formulate recommendations for practitioners aiming to discontinue long-term opioid therapy. Specifically, this review aims to answer the following questions: What is an optimal opioid tapering regimen? How can the risks involved in a taper be managed? What are the alternatives to an opioid taper? A PubMed literature search was conducted using the keywords chronic pain combined with opioid withdrawal, taper, wean and detoxification. Six hundred ninety-five documents were identified and screened; 117 were deemed directly relevant and are included. On the base of this literature review, this article proposes evidence-based recommendations and expert-based suggestions for clinical practice. Furthermore, areas of lack of evidence are identified, providing opportunities for further research.

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Longitudinal Observation of Changes in Pain Sensitivity during Opioid Tapering in Patients with Chronic Low-Back Pain

Abstract: Our findings suggest that long-term use of opioids does not reduce pain sensitivity in cLBP patients; opioid tapering may induce brief hyperalgesia that can be normalized over a longer period.

Cited by 38 publications

References 30 publications

Withdrawal-associated injury site pain (WISP): a descriptive case series of an opioid cessation phenomenon

Withdrawal-associated injury site pain (WISP): a descriptive case series of an opioid cessation phenomenon

Self-Loathing Aspects of Depression Reduce Postoperative Opioid Cessation Rate

Tapering Long-term Opioid Therapy in Chronic Noncancer Pain

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