Intensity of Withdrawal Symptoms During Opioid Taper in Patients with Chronic Pain-Individualized or Fixed Starting Dosage?

Pain Medicine : the Official Journal of the American Academy of Pain Medicine
Natalia BienekChristine H Meyer-Frießem

Abstract

Controlled opioid withdrawal is recommended for patients with chronic noncancer pain (CNCP) with insufficient pain reduction or intolerable side effects while on opioid treatment. Few studies have investigated the management of opioid withdrawal (OW). Most common are protocols with an individualized starting dosage (ISD), calculated from the last opioid intake. After two cases of overdose, we introduced a novel withdrawal protocol using a low fixed starting dosage (FSD) for safety reasons. The present study compares the intensity of withdrawal symptoms using the Subjective Opioid Withdrawal Scale (SOWS) and incidences of serious adverse events (SAE) and dropouts in each taper schedule in 195 CNCP patients with OW in an inpatient facility. Two protocols were compared: FSD (2014-2016): N = 68, starting dose: 90 mg morphine/d; and ISD (2010-2014): N = 127, starting dose: 70% of the patient's daily morphine equivalent dose (MED). Outcome criteria: primary: mean daily SOWS score during the first 10 days (16 questions, daily score 0-64); secondary: change in pain intensity on a numeric rating scale (0-10), rate of dropouts and SAEs. Statistics: Student test, Mann-Whitney U test, chi-square test, analysis of variance, P < 0.05. The me...Continue Reading

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Citations

Oct 29, 2020·Internal Medicine Journal·Paul GlareMichael Nicholas
Apr 17, 2021·Pain Medicine : the Official Journal of the American Academy of Pain Medicine·David A Fishbain
Jun 4, 2021·Journal of Substance Abuse Treatment·Sara Rodríguez-EspinosaJosé L Carballo
Jun 4, 2021·Journal of Substance Abuse Treatment·Colleen B MistlerRoman Shrestha

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