Multidisciplinary Approach to Opioid Reduction Can Achieve Dosage Goals

In light of issues concerning opioid misuse and dependence running parallel to the tenfold increase of prescription opioid use over the past 20 years, a team of researchers have developed an ongoing study examining results of a pilot program aimed at reducing patients’ use of pain medications.

For their “A multidisciplinary outpatient pain management opioid reduction pilot program” study, Patricia Tsui, PhD, a clinical psychologist at the Center for Pain Management at Stony Brook, in Stony Brook, NY, and colleagues reviewed the medical charts and medication histories of seven patients enrolled in a pain medication safety class at an academic multidisciplinary outpatient pain management center. The participants — most of whom had chronic back pain with overlapping or multiple pain conditions — were either self-referred or referred by their physicians to the opioid reduction program, “thus, some patients were actively trying to reduce opioid consumption, but some were not,” the authors wrote.

Aside from the pain medication safety class, opioid reduction strategies executed in the study included involvement in mental health services, such as psychiatry and psychotherapy, as well as “improved patient-provider communication, such as more honesty and insight with regards to pain medication use to help guide treatment plans,” according to the authors.

Thus far, three of the participants have reduced their opioid use, and after converting pain medications to their morphine equivalents, end dosages ranged from 0 milligrams to 30 milligrams per day, compared to the starting dosages range from 22.5 milligrams to 270 milligrams per day. At an author-attended poster session at the 32nd Annual Scientific Meeting of the American Pain Society, Tsui said participants who were actively attempting to reduce their pain medications had a mean reduction of 105 milligrams per day while maintaining fairly stable pain levels. On the flip side, patients who were not trying to reduce their opioid medications had a mean increase of 0.28 milligrams per day.

“It may be that decreasing opioids was not appropriate for some patients or perhaps some were in earlier stages of behavior change and not ready to change their opioid use for chronic pain,” the authors hypothesized in the study. “A different type of intervention such as motivational interviewing may be more suited for some in this patient group.”

Though collaborative treatment planning was vital in achieving dosage goals, Tsui said the responsibility to limit opioid medications heavily falls on physicians’ shoulders.

“It’s a lot of work on the providers’ part because they ultimately have to convince the patient to reduce opioid use,” Tsui said. “The doctor sets limits and it becomes a negotiation game with the patient, where the doctor will ask the patient to take 10 less milligrams of morphine equivalent a day and they’ll settle on five.”

In terms of implementing the multidisciplinary opioid reduction program, Tsui said not all pain management physicians have the resources to provide mental health services — including the outpatient pain management center utilized in the study, which she said lacked in-house psychiatrists — so it’s crucial to locate good referral sources for those treatments to accomplish that pain care approach.

“Chronic pain has a far reach in its physical, mental, and social impact. Therefore, a multidisciplinary approach to patient care — especially one where the patient’s mental health needs are considered — is best positioned for improving the patient’s condition as supported with this study and previous research,” the authors wrote. “This is particularly important for patients with long-standing psychiatric comorbidities; follow-up with mental health providers can provide the essential support necessary for the patients’ overall well-being.”

Tsui said data collection for the study is ongoing, and she anticipates more in-depth outcomes will be released at a later time.