Weaning Off of Opioids- Safest Path to Pain Control
The US Centers for Disease Control and Prevention has established guidelines on prescribing opioids, recommending that long-term opioid users be weaned or tapered off pain pills. This is because opioids only provide a short term benefit, but this benefit decreases with time. With continued opioid use, receptors in the brain become used to the amount of opioid they are experiencing and no longer produce the same pain-relieving effects. In addition, with time and continued opioid use, the brain creates new nerve connection pathways that establish and reinforce the need for opioids. Ongoing use of opioids is therefore associated with risk of addiction, diminished pain control and reduced quality of life.
Though the thought of discontinuing opioids can cause uneasiness and concern for patients who have long relied on them for control of their pain, a study in the journal Annals of Internal Medicine found that chronic pain patients who taper off opioids have a better quality of life. I believe that tapering off opioids will improve the quality of my patients' lives as well and I am committed to helping them succeed.
Though the thought of discontinuing opioids can cause uneasiness and concern for patients who have long relied on them for control of their pain, a study in the journal Annals of Internal Medicine found that chronic pain patients who taper off opioids have a better quality of life. I believe that tapering off opioids will improve the quality of my patients' lives as well and I am committed to helping them succeed.
Cutting Down Opioids
I advocate a gradual decrease of the dose of opioid medication.
Plan to Slowly Decrease Opioid Dose
1) Prior to initiating a taper I will assess:
a) Depression Risk- depression makes a taper harder to achieve
b) Pain- patients with high pain scores are less able to taper
c) Opioid Dose- patients taking high doses of opioids need to decrease slowly
2) We will meet monthly to formulate a treatment plan
3) Goal is to decrease your opioid dose by 10% per step down monthly. There is no rigid time interval between dose decreases. I recommend decreasing monthly. A decrease of 10% of the original dose rarely precipitates withdrawal symptoms.
4) You will need a pill splitter to cut tablets.
a) Depression Risk- depression makes a taper harder to achieve
b) Pain- patients with high pain scores are less able to taper
c) Opioid Dose- patients taking high doses of opioids need to decrease slowly
2) We will meet monthly to formulate a treatment plan
3) Goal is to decrease your opioid dose by 10% per step down monthly. There is no rigid time interval between dose decreases. I recommend decreasing monthly. A decrease of 10% of the original dose rarely precipitates withdrawal symptoms.
4) You will need a pill splitter to cut tablets.
Short Term Risks of Tapering Off of Opioids
1) Withdrawal- You may experience symptoms such as anxiety, restlessness, and insomnia. Of course, I will try to minimize withdrawal symptoms.
2) Increased Pain- Patients fear that their pain will increase during an opioid taper. However, in studies of long-term opioid treatment tapers patients usually report improvements in function without associated worsening in pain .
3) Dropout- I want to continue to serve patients treated with long term opioids.
2) Increased Pain- Patients fear that their pain will increase during an opioid taper. However, in studies of long-term opioid treatment tapers patients usually report improvements in function without associated worsening in pain .
3) Dropout- I want to continue to serve patients treated with long term opioids.
Long Term Issues Related to Tapering Off of Opioids
1) Relapse- Goals of opioid taper are to reduce risks of long-term opioid treatment (opioid reliance, chemical coping, and self-medication with risk of overdose), and maintain reduced opioid consumption or abstinence.
2) Function- Increasing or maintaining function is a key long-term goal in treating those with chronic pain.
2) Function- Increasing or maintaining function is a key long-term goal in treating those with chronic pain.
Other Thoughts to Increase Success of Taper
1) Other modalities may help you deal with pain- PT, acupuncture, massage
2) Involve a friend or family member to support your taper.
3) Professional counseling may help you succeed.
4) Do everything you can to live well
a) Exercise daily for at least 30 minutes
b) Sleeping well helps- go to bed and wake at nearly the same time daily
c) Don't smoke- nicotine interferes with pain perception
d) Communicate with your network of friends- being connected helps
e) Meditative techniques help- deep breathing, progressive relaxation, yoga
2) Involve a friend or family member to support your taper.
3) Professional counseling may help you succeed.
4) Do everything you can to live well
a) Exercise daily for at least 30 minutes
b) Sleeping well helps- go to bed and wake at nearly the same time daily
c) Don't smoke- nicotine interferes with pain perception
d) Communicate with your network of friends- being connected helps
e) Meditative techniques help- deep breathing, progressive relaxation, yoga