Slow opioid tapering compared to continued stable opioid therapy for chronic noncancer pain: A double-blinded randomized controlled trial

OBJECTIVE: To investigate whether gradually discontinuing chronic opioid therapy (COT) affects quality of life (QOL), depression, and anxiety. DESIGN: Double-blinded, randomized controlled trial. SETTING: Ten primary care clinics in Wisconsin. PARTICIPANTS: Adults on stable doses of COT for chronic noncancer pain. INTERVENTIONS: Participants were blinded and randomized to either a slow taper or to continue their COT. Participants were assessed at baseline, 3, 6, 9, and 12 months post-enrollment. OUTCOME MEASURES: Primary outcomes were study completion and QOL, measured by the Medical Outcomes Study Questionnaire Short Form 36 Health Survey version 2. Secondary outcomes were depression and anxiety symptoms, measured using the Patient Health Questionnaire-9 Depression Scale and the Generalized Anxiety Disorder-7 Anxiety Scale, respectively. RESULTS: Of the 1,140 patients invited to participate, 18 enrolled-all prescribed tramadol or hydrocodone at the time of enrollment (median morphine milligram equivalents per day [MMED] of 17.5 mg; range: 5-40 MMED). Both groups had similar QOL and depression symptoms. The tapering group reported increased anxiety (p = 0.04). CONCLUSION: Our findings suggest that opioids can be slowly tapered without affecting QOL or depression. Tapering led to a slight increase in anxiety. Larger-scale studies are needed to confirm our findings. TRIAL REGISTRATION NUMBER: 21-009836 (ClinicalTrials.gov, Home | ClinicalTrials.gov). The trial was registered on March 22, 2022, "Slow Opioid Tapering Pilot Study of Patients Using Chronic Opioid Therapy."