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Potential impact of abrupt opioid therapy discontinuation in the management of chronic pain: A pilot study on patient perspective

Joy Hao, MD, PhD, David Lucido, PhD, Ricardo A. Cruciani, MD, PhD


Objectives: This survey highlights the perspective of patients with chronic pain when confronted with the possibility of abrupt opioid discontinuation.

Design: Anonymous and self-administered survey.

Setting: Pain Clinic in an urban academic hospital setting.

Participants: Patients with chronic pain of at least 6 months, and age 18 years or older.

Main outcome measures: The perceived impact of abrupt opioid discontinuation on mood, daily functioning, and potential for opioid misuse.

Results: When patients were asked how they would feel if told their opioids would be discontinued, the responses were neglected (scale mean, 7.1), angry (6.3), helpless (6.7), and upset (7.0) on a scale of 0-10. The majority predicted loss of independence in activities of daily living (scale mean, 7.5), inability to enjoy their lives (7.4), and inability to work (7.8). A group of 19 patients (11.6 percent) reported that they would obtain opioids from friends or family, and 7 (4.4 percent) would obtain them illegally. These patients reported higher scores of neglect, anger, suspicion, helplessness, and upset (p = 0.000-0.019) and were more likely to have previously obtained opioids illegally (p = 0.008-0.023). The most common nonopioid strategies tried by patients were lumbar epidural (71.5 percent), physical therapy (78.9 percent), and exercise (83.5 percent). The strategies considered to be effective as opioid replacement therapy were lumbar epidural (42.3 percent), exercise (43.2 percent), and massage (42.0 percent).

Conclusions: These data suggest that opioid therapy discontinuation is an emotionally distressing experience for most patients, and the transition to nonopioid treatments is a complex process that will require patient participation to achieve optimal care.


opioid discontinuation, exit strategy, chronic pain

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Webster LR, Cochella S, Dasgupta N, et al.: An analysis of the root causes for opioid-related overdose deaths in the United States. Pain Med. 2011; 12(suppl 2): S26-S35.

Fishbain DA, Cole B, Lewis J, et al.: What percentage of chronic nonmalignant pain patients exposed to chronic opioid analgesic therapy develop abuse/addiction and/or aberrant drug-related behaviors? A structured evidence-based review. Pain Med. 2008; 9(4): 444-459.

US Food and Drug Administration. FDA Introduces New Safety Measures for Extended-Release and Long-Acting Opioid Medications. Available at Accessed December 9, 2013.

De Leon-Casasola OA: Opioids for chronic pain: New evidence, new strategies, safe prescribing. Am J Med. 2013; 126(3 suppl 1): S3-S11.

Chou R, Fanciullo GJ, Fine PG, et al.: Opioid treatment guidelines clinical guidelines for the use of chronic opioid therapy in chronic noncancer pain. J Pain. 2009; 10(2): 113-130.

Breuer B, Cruciani RA, Portenoy RK: Pain management by primary care physicians, pain physicians, chiropractors, and acupuncturists: A national survey. South Med J. 2010; 103(8): 738-747.

Gourlay DL, Heit HA: Pain and addiction: Managing risk through comprehensive care. J Addict Dis. 2008; 27(3): 23-30.

Meier B: Tightening the lid on pain prescriptions. New York Times. April 8, 2012. Available at Accessed December 9, 2013.

Zuger A: Hard cases: the traps of treating pain. New York Times. May 13, 2013. Available at Accessed December 9, 2013.

Ungar L: Painkiller crackdown could harm the truly needy. The Courier-Journal. June 4, 2012. Available at Accessed December 9, 2013.

Association of American Physicians and Surgeons, Inc.: Doctors Say US Drug Policy Forces Pain Patients to Extreme Measures, Turns Doctors into Criminals, Florida’s War on Drugs now a War on Doctors. 2003 [Press release]. Available at Accessed December 9, 2013.

Turk DC, Wilson HD, Cahana A: Treatment of chronic noncancer pain. Lancet. 2011; 377: 2226-2235.

Turk DC, Dworkin RH, Revicki D, et al.: Identifying important outcome domains for chronic pain clinical trials: An IMMPACT survey of people with pain. Pain. 2008; 137(2): 276-285.

Barnes PM, Powell-Griner E, McFann K, et al.: Complementary and alternative medicine use among adults: United States, 2002. Adv Data. 2004; (343): 1-19.

United States v. Boidi, 568 F.3d 24, 29 (1st Cir 2009).

United States v. Cortes-Caban, 691 F.3d 1 (1st Cir 2012).

Substance Abuse and Mental Health Services Administration, Office of Applied Studies: Results from the 2007 National Survey on Drug Use and Health: National Findings. Rockville, MD: SAMHSA, 2008. Available at Accessed December 9, 2013.

Ives TJ, Chelminski PR, Hammett-Stabler CA, et al.: Predictors of opioid misuse in patients with chronic pain: A prospective cohort study. BMC Health Serv Res. 2006; 6: 46.

Dillman DA (ed.): Mail and Internet Surveys: The Tailored Design Method. New York: Wiley, 2000.

Dillman DA: Mail and other self administered surveys in the 21st century: The beginning of a new era. Gallup Res J. 1998; (March): 1-24.



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