Table 1:

The effect of opioid tapering versus maintaining the dose for adult patients with chronic noncancer pain using 90 mg morphine equivalents of opioids per day or more*

Outcome follow-upNo. of studiesAbsolute effect estimatesQuality of evidencePlain language summary
Pain (11-point NRS; lower is better) 6–12 mo2 studies (73 patients)42,43In one study,42 pain was reduced on an 11-point NRS from mean (SD) of 8.00 (0.30) at baseline to 3.35 (0.33) at 6 mo. In the other study,43 40% of patients reported less pain, 28% reported no change and 33% reported more pain after taperingVery low, due to serious risk of bias and serious imprecision§We are uncertain about the effect of tapering on pain
Success of tapering 6–12 mo2 studies (73 patients)42,43In one study,42 100% of patients successfully tapered opioids. In the other study,43 47 of 50 (94%) of patients successfully tapered opioidsLow, due to serious indirectness and serious imprecision§Success of tapering may be high in this patient population
  • Note: NRS = Numeric Pain Rating Scale, SD = standard deviation.

  • * Available at www.magicapp.org/SoF9.

  • Minimally important difference for pain on an 11-point NRS is a reduction of 2 points.

  • Neither study enrolled a comparison group.

  • § Small number of patients.

  • These 2 studies defined “success of tapering” differently. Baron and McDonald42 enrolled patients into a voluntary inpatient detoxification program intended to taper them off prescription opioids if the patient or physician felt that the patient was not getting benefit from high doses of opioids. No patient was referred for diversion, overuse, abuse or addiction to opioids. The goal of the program was to taper patients completely off opioids. Harden and colleagues43 included individuals drawn from a list of patients initiated on an opioid taper at a US Veterans Affairs medical centre. A taper was considered successful if the patient’s dose at 12 months was less than the baseline dose.