Patients with problematic opioid use can be weaned from codeine without pain escalation.
BACKGROUND
Brief treatments for chronic non-malignant pain patients with problematic opioid use are warranted. The aims of the present study were to investigate (1) whether it is possible to withdraw codeine use in such patients with a brief cognitive-behavioural therapy (CBT), (2) whether this could be done without pain escalation and reduction in quality of life and (3) to explore the effects of codeine reduction on neurocognitive functioning.


METHODS
Eleven patients using codeine daily corresponding to 40-100 mg morphine were included. Two specifically trained physicians treated the patients with six CBT sessions, tapering codeine gradually within 8 weeks. Codeine use, pain intensity, quality of life and neuropsychological functioning were assessed at pre-treatment to the 3-month follow-up.


RESULTS
Codeine use was significantly reduced from mean 237 mg [standard deviation (SD) 65] pre-treatment to 45 mg (SD 66) post-treatment and to 48 mg (SD 65) at follow-up without significant pain escalation or reductions in quality of life. Moreover, neuropsychological functioning improved significantly on some tests, while others remained unchanged.


CONCLUSIONS
The promising findings of codeine reduction in this weaning therapy programme for pain patients with problematic opioid use should be further evaluated in a larger randomized control trial comparing this brief CBT with both another brief treatment and attention placebo condition.
Nilsen
H K
HK
Pain and Palliation Research Group, Institute of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway. halvardnilsen@yahoo.no
Stiles
T C
TC
Landrø
N I
NI
Fors
E A
EA
Kaasa
S
S
Borchgrevink
P C
PC
D000328:Adult; D000701:Analgesics, Opioid / Q000008:administration & dosage*; D000704:Analysis of Variance; D002908:Chronic Disease; D003061:Codeine / Q000008:administration & dosage*; D003071:Cognition / Q000187:drug effects; D015928:Cognitive Behavioral Therapy / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006304:Health Status; D006801:Humans; D008297:Male; D008875:Middle Aged; D009483:Neuropsychological Tests; D010146:Pain / Q000188:drug therapy*; D010147:Pain Measurement; D011788:Quality of Life / Q000523:psychology; D019966:Substance-Related Disorders / Q000517:prevention & control*; D055815:Young Adult
D000701:Analgesics, Opioid; D003061:Codeine