Association Between Pain Intensity and Discontinuing Opioid Therapy or Transitioning to Intermittent Opioid Therapy After Initial Long-Term Opioid Therapy: A Retrospective Cohort Study

Corey J. Hayes, Erin E. Krebs, Joshua Brown, Chenghui Li, Teresa Hudson, Bradley C. Martin

Research output: Contribution to journalArticlepeer-review

Abstract

The purpose of this study was to evaluate changes in pain intensity among Veterans transitioning from long-term opioid therapy (LTOT) to either intermittent therapy or discontinuation compared to continued LTOT. Pain intensity was assessed using the Numeric Rating Scale in 90-day increments starting in the 90-day period prior to potential opioid transitions and the two ensuing 90-day periods after transition. Primary analyses used a 1:1 greedy propensity matched sample. A total of 29,293 Veterans switching to intermittent opioids and 5,972 discontinuing opioids were matched to Veterans continuing LTOT. Covariates were well balanced after matching except minor differences in baseline mean pain scores. Pain scores were lower in the follow up periods for those switching to intermittent opioids and discontinuing opioids compared to those continuing LTOT (0–90 days: Intermittent: 3.79, 95%CI: 3.76, 3.82; LTOT: 4.09, 95%CI: 4.06, 4.12, P < .0001; Discontinuation: 3.06, 95%CI: 2.99, 3.13; LTOT: 3.86, 95%CI: 3.79, 3.94, P = <.0001; 91–180 days: Intermittent: 3.76, 95%CI: 3.73, 3.79; LTOT: 3.99, 95%CI: 3.96, 4.02, P < .0001; Discontinuation: 3.01, 95%CI: 2.94, 3.09; LTOT: 3.80, 95%CI: 3.73, 3.87, P = <.0001). Sensitivity analyses found similar results. Discontinuing opioid therapy or switching to intermittent opioid therapy was not associated with increased pain intensity. Perspective: This article evaluates the association of switching to intermittent opioid therapy or discontinuing opioids with pain intensity after using opioids long-term. Pain intensity decreased after switching to intermittent therapy or discontinuing opioids, but remained relatively stable for those continuing long-term opioid therapy. Switching to intermittent opioids or discontinuing opioids was not associated with increased pain intensity.

Original languageEnglish (US)
JournalJournal of Pain
Early online dateJun 27 2021
DOIs
StateE-pub ahead of print - Jun 27 2021

Bibliographical note

Funding Information:
Funding: Research reported in this publication was supported by the National Institute on Drug Abuse of the National Institutes of Health under Award Number R36DA046717. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. Dr. Hayes was also supported by the National Institute on Drug Abuse under the Translational Training in Addiction Grant [1T32 DA 022981]. This material is the result of work supported with resources and the use of facilities at the Veterans Health Administration.

Publisher Copyright:
© 2021

Keywords

  • Numeric Rating Scale
  • chronic opioid discontinuation
  • intermittent opioid use
  • opioids
  • pain intensity
  • pain scores

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