Individualized opioid tapering in a community interdisciplinary pain management program with flexible care plans: Outcomes, patient retention, and follow-up.

Abstract

Objective: To evaluate the effectiveness of an outpatient, interdisciplinary pain management (IPM) program offering individualized opioid tapering as part of flexible, patient-specific care plans, in achieving the dual goals of improved management of chronic nonmalignant pain (CNMP) and substantial reduction of opioid use.

Design: A retrospective cohort study, comprising a cohort of patients who presented on opioid therapy and a cohort who did not.

Setting: Community outpatient IPM program.

Participants: Patients presenting between April 1, 2016 and September 15, 2019. From an initial pool of 402 patients, inclusion and exclusion criteria identified 300 patients for analyses.

Interventions: Engagement in a comprehensive and flexible IPM program with patient-specific care plans that included individualized opioid tapering.

Main outcome measure(s): Changes in pain intensity, pain interference, physical therapy (PT) metrics, patient retention, and follow-up of opioid use status at least 3 years after the end of each patient's study episode of care.

Results: Changes in pain intensity and interference, and PT outcomes reflected notable improvements in pain management, with no significant overall differences between cohorts. During study episodes of care, all patients in the opioid cohort reduced opioid use and two-thirds discontinued opioids; patient retention was 90.9 percent. In follow-up of over 80 percent of the opioid cohort up to an average of 4.5 years, opioid use for CNMP decreased to 15.8 percent of patients.

Conclusions: A flexible, patient-centered IPM program can improve the management of CNMP, substantially reduce opioid use, and maintain a high rate of patient retention. During follow-up, patients further reduced their use of opioids for CNMP.