PainRelief.com Interview with:
Dr Stephanie Mathieson PhD
NHMRC Health Professional Research Early Career Fellow
The University of SydneyFaculty of Medicine and Health, Sydney School of Public Health
Dr Stephanie Mathieson is a Research Fellow at the Institute for Musculoskeletal Health, The University of Sydney. Her National Health and Medical Research Council (NHMRC) Health Professional Research Early Career Fellow is focused around reducing the opioid epidemic in Australia.
PainRelief.com: What is the background for this study?
Response: This study aimed to review the current evidence of the efficacy of interventions designed to reduce/cease the prescription of, or the use of, opioid analgesics in patients with chronic non-cancer pain.
As clinical practice guidelines now discourage the initial prescription of opioid analgesics for chronic non-cancer pain, clinicians need to know which opioid dose reduction methods are most effective and safe for deprescribing opioid analgesics in their patients.
PainRelief.com:? What are the main findings?
Response: Our systematic review extended the previous body of literature by incorporating five new randomised trials; however, clinical and statistical heterogeneity prevented meta-analysis. There were ten patient-focused interventions (i.e. aimed at reducing a patient’s opioid dose), and two clinician focused interventions (i.e. aimed at changing the clinician’s behaviour). Overall, our review was unable to recommend any one opioid analgesic deprescribing strategy in patients with chronic pain due to the small number of trials and heterogeneity.
PainRelief.com: What should readers take away from your report?
Response: Clinicians should not be discouraged to deprescribe opioids in patients who have chronic non-cancer pain, particularly when the risks of harms outweigh the benefits. Although currently there is uncertainty on which evidence-based strategies are most effective to deprescribe opioids in patients with chronic pain, clinicians may reflect on individual studies for empirical evidence to guide their decisions. For instance, two studies showed the benefits of behavioural approaches when incorporated into the deprescribing process. Strategies that aimed at changing clinician prescribing behaviour did reduce opioid prescribing long-term and may be a future implementable deprescribing strategy upon further research.
PainRelief.com: What recommendations do you have for future research as a result of this work?
Response: Our review highlights the urgent need for more research in this area. Trials are needed to identify evidence-
based methods on how best to decrease the use of opioid analgesics in chronic non-cancer pain. The breath of interventions to reduce opioid use found in our review highlights that deprescribing is complex, and no single strategy is suited for all patients. Future research is also needed to establish effective strategies to reduce the initial prescription of opioid analgesics, which in turn may prevent the potential need for future opioid deprescribing strategies.
Mathieson, S., Maher, C.G., Ferreira, G.E. et al. Deprescribing Opioids in Chronic Non-cancer Pain: Systematic Review of Randomised Trials. Drugs (2020). https://doi.org/10.1007/s40265-020-01368-y
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