No Change in Pain or Depression Outcomes After Implementation of Clinic-based Opioid Dose Reduction and Risk Mitigation Strategies

Clinic-level interventions aiming to reduce opioid dose and mitigate risks of long-term opioid therapy could have adverse effects on pain, function, and depression symptoms. Researchers conducted telephone interviews among patients receiving long-term opioid therapy at primary care clinics conducting dose reduction and risk mitigation interventions (n=935), compared with patients in clinics without such interventions (n=653).

• Response rates were 40% (intervention group) and 28% (control).
• The average age was 62 and two-thirds of patients had a mental health disorder diagnosis; patients in intervention clinics had lower opioid doses compared with controls (mean daily morphine-equivalent dose 47 mg versus 74 mg, respectively).
• After controlling for patient characteristics and co-morbidity and weighted for non-response, there were no significant differences in pain scores between intervention and control clinic patients, or in items related to pain intensity, interference in activities, or enjoyment of life.
• Depression scores (PHQ-8, range 0–24) were lower in intervention clinic patients, but the difference was not clinically significant. There were no significant differences in patient reported opioid-related pain relief or side effects.

Comments: While significantly limited by a low response rate and non-randomized observational design, this study found no evidence that clinic-level dose reduction and risk mitigation strategies were associated with clinically meaningful changes in chronic pain outcomes or depression symptoms. These data support efforts to implement opioid prescribing guidelines such as those from the Centers for Disease Control and Prevention.

Joseph Merrill, MD, MPH

Reference: Thakral M, Walker RL, Saunders K, et al. Comparing pain and depressive symptoms of chronic opioid therapy patients receiving dose reduction and risk mitigation initiatives with usual care. J Pain. 2018;19(1):111–120.