Several health organizations, including the CDC, have recommended dose reduction and risk mitigation strategies to reduce adverse events for patients on chronic opioid therapy. A new study published in The Journal of Pain reports that patients with chronic pain treated in centers with opioid-dose reduction policies show no clinically meaningful differences in pain intensity, interference with daily activities, enjoyment of life, or depressive symptoms. The Journal of Pain is published by the American Pain Society, www.americanpainsociety.org.

Researchers from Kaiser Permanente and the University of Washington compared outcomes for some 1,600 patients with chronic pain who were treated in a large health-care system in Washington that adopted opioid-dose reduction strategies with groups of patients treated in clinics that did not implement dose reductions. They compared pain intensity, pain-related interference in activities, depressive symptoms, perceptions of pain relief, and side effects.

The authors noted that few studies have investigated the impact of opioid-dose reduction strategies. But high-dose chronic opioid therapy has been associated with poor pain control in patient surveys, suggesting that dose escalation might not be the appropriate response for ineffective pain management.

Results showed no evidence that patients treated in dose-reducing clinics had worse pain symptoms than those treated at clinics not using dose reduction strategies. There was no difference in pain intensity, pain-related interference in daily activities, and enjoyment of life. Also, the dose-reduction group showed slightly better depression scores, and only a few patients said they considered opioid side effects as bothersome.