Chronic pain: it's proven, it's better to stop opioids

Researchers at Washington State University (USA) have found that stopping long-term opioid treatment does not worsen chronic pain. In France, at least 12 million people suffer from it.

While potent opioid analgesics have been used extensively to treat chronic pain in the United States since the 1990s, an increasing number of drug-related overdose deaths have prompted US physicians and policy makers to reconsider this approach.
With this in mind, researchers at Washington State University (USA) have found that stopping long-term opioid therapy does not worsen chronic pain. It is therefore better, in this case, to stop them. According to the Centers for Disease Control and Prevention, more than 63,600 Americans died of drug overdose in 2016, five times more than in 1999. Two-thirds of these deaths, or 42,249 deaths, involved opioids.

551 patients tested

This new trial provides insight into how stopping long-term opioid therapy affects patients with different types of chronic pain, and could help physicians identify effective alternative treatments. "On average, the pain did not worsen in patients in our study one year after stopping opioid therapy in the long term," says Sterling McPherson, associate professor and director of clinical trials at WSU Elson F. Floyd College of Medicine. "In fact, their chronic pain has even slightly decreased just after stopping treatment, especially in patients with mild to moderate pain," he says.
McPherson and colleagues used the responses of 551 patients who had long-term opioid treatment for chronic (non-cancer) pain for at least one year before stopping the medication. 87% of the patients in this cohort had chronic musculoskeletal pain, 6% neuropathic pain and 11% headache, including migraines.

Subjects rated their pain over a two-year period, with a scale of 0 to 10, where 0 equals no pain and 10 the worst possible pain. Researchers used biostatistical analysis and computer modeling to characterize changes in pain intensity 12 months before the end of opioid therapy and 12 months later. Although the intensity of pain experienced before and after opioid withdrawal varied considerably from one patient to another, overall, the pain did not worsen, and remained the same or slightly decreased.

Promote conversations between doctors and their patients

"There is a wide variety of treatments available for the management of chronic pain other than opioids, and we hope this research will help promote conversations about these alternatives between physicians and their patients," says McPherson. His team plans to collect additional data to try to determine why some patients experience greater pain reductions than others after stopping long-term opioid therapy.

Back pain, headaches and other chronic pain already affect a third of Americans, a proportion that worsens as the prevalence of diabetes, obesity and arthritis increases. In France, at least 12 million people suffer from chronic pain, and "70% of these 12 million patients do not receive appropriate treatment", denounced last year the specialists gathered within the French Society of study and pain treatment (SFETD). In other words, 8.4 million French people could suffer less if they were better supported.