More than 50 million people in the United States live with chronic pain, a condition that lasts for months or even years. Many of these people rely on prescription opioid medicines to control their pain.
About one in ten people with chronic pain take these medicines regularly. Opioids can provide important pain relief, but long-term use can also lead to physical dependence, meaning the body becomes used to the medicine. Because of this, many patients worry that reducing their dose will make their pain worse or cause severe withdrawal symptoms.
A new study led by Stanford Medicine offers encouraging news. The research, published in the Annals of Internal Medicine, found that many people can successfully lower their opioid use without increasing their pain if the process is slow, flexible, and controlled by the patient.
The researchers enrolled more than 500 adults who had experienced pain for at least six months and had taken prescription opioids for at least three months. On average, participants had been using opioids for more than 12 years.
Instead of following a strict schedule, each patient worked closely with their healthcare provider to create a personalized plan.
The goal was to reach the lowest comfortable opioid dose over one year. Doses were reduced by no more than 10% each month, and patients could slow down or pause the process whenever needed after discussing it with their clinician.
After 12 months, about half of the participants achieved a successful outcome. Success meant either reducing their opioid dose by at least half without worsening pain or staying on the same dose while experiencing much less pain. These results suggest that many patients do not need to choose between pain control and reducing opioid use.
The study also tested whether adding behavioral support would improve results. Some participants received cognitive behavioral therapy, while others joined a peer-led chronic pain self-management program.
A third group followed only the patient-centered tapering plan. Surprisingly, the extra programs did not improve the overall tapering success rate. However, cognitive behavioral therapy did reduce withdrawal symptoms, making the process more comfortable for many patients.
Researchers say this study is different because it gives patients control. Earlier efforts to reduce opioid use often happened too quickly. After opioid prescribing guidelines were released in 2016, some patients had their medicines reduced or stopped abruptly.
Many experienced severe withdrawal, emotional distress, or even turned to dangerous illegal drugs. The new research shows that these poor outcomes were often linked to tapering too fast rather than tapering itself.
An important part of the study was an electronic platform called CHOIR. It checked in with patients regularly, monitored symptoms, and alerted doctors if someone reported serious problems. The system also adjusted each patient’s tapering schedule as needed, helping clinicians provide more personalized care.
The researchers found another interesting result. Patients who felt mentally ready to reduce their opioid use at the beginning of the study were more likely to succeed. This highlights the importance of building trust, reducing fear, and allowing patients to participate in every decision.
The study was not designed for people with moderate or severe opioid addiction. Instead, it focused on people who had become physically dependent after using prescription opioids for chronic pain under medical care.
The findings support current recommendations that opioid doses should be reduced gradually and with shared decision-making between patients and healthcare providers. They also show that many people may safely lower their opioid use while maintaining good pain control.
This is a large, well-designed clinical study involving patients from multiple healthcare centers, making the findings more reliable than many earlier studies. The patient-centered design is a major strength because it reflects real-world clinical practice.
However, only about half of participants achieved successful tapering, showing that the process remains challenging and must be individualized. Future research should examine how digital support tools and behavioral therapies can further improve long-term outcomes.
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Source: Stanford Medicine.
