RT Journal Article
SR Electronic
T1 Opioid reduction for patients with chronic pain in primary care: systematic review
JF British Journal of General Practice
JO Br J Gen Pract
FD British Journal of General Practice
SP e293
OP e300
DO 10.3399/BJGP.2021.0537
VO 72
IS 717
A1 Loes de Kleijn
A1 Julie Rønne Pedersen
A1 Hanneke Rijkels-Otters
A1 Alessandro Chiarotto
A1 Bart Koes
YR 2022
UL http://bjgp.org/content/72/717/e293.abstract
AB Background Long-term opioid treatment in patients with chronic pain is often ineffective and possibly harmful. These patients are often managed by GPs who are calling for a clear overview of effective opioid reduction strategies for primary care.Aim To evaluate effectiveness of opioid reduction strategies applicable in primary care for patients with chronic pain on long-term opioid treatment.Design and setting Systematic review of controlled trials and cohort studies performed in primary care from inception date to 15 January 2021.Method Literature search conducted in EMBASE, MEDLINE, Web of Science, Cochrane Central Register of Controlled Trials, CINAHL, Google Scholar, and PsycINFO. Studies evaluating opioid reduction interventions applicable in primary care among adults on long-term opioid treatment for chronic non-cancer pain were included. Risk of bias was assessed using the Cochrane risk-of-bias tool (version 2) (RoB 2) or the Risk of bias in non-randomized studies — of interventions (ROBINS-I) tool. Narrative synthesis was performed because of clinical heterogeneity in study designs and types of interventions.Results In total, five randomised controlled trials (RCTs) and five cohort studies were included (N = 1717, range n = 35 to n = 985) exploring various opioid reduction strategies. Of these, six studies had high/critical RoB, three moderate RoB, and one low RoB. Three cohort studies: investigating a GP-supervised opioid taper (critical ROBINS-I), an integrative pain treatment (moderate ROBINS-I), and group medical visits (critical ROBINS-I) demonstrated significant between-group opioid reduction.Conclusion Results carefully point in the direction of a GP supervised tapering and multidisciplinary group therapeutic sessions to reduce long-term opioid treatment. However, because of high risk of bias and small sample sizes, no firm conclusions can be made demonstrating the need for more high-quality research.