title: Interventions for the reduction of prescribed opioid use in chronic non-cancer pain.
abstract: BACKGROUND
  Patients with chronic non-cancer pain who are prescribed and are taking opioids can have a history of long term high dose opioid use without effective pain relief. In those without good pain relief, reduction of prescribed opioid dose may be the desired and shared goal of both patient and clinician. Simple unsupervised reduction of opioid use is clinically challenging, and very difficult to achieve and maintain.
  
  
  OBJECTIVE
  To investigate the effectiveness of different methods designed to achieve reduction or cessation of prescribed opioid use for the management of chronic non-cancer pain.
  
  
  METHODS
  We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, and EMBASE from inception to 8th April 2013, as well as bibliographies.
  
  
  METHODS
  Included studies had to be randomised controlled trials comparing opioid users receiving an intervention with a control group receiving treatment as usual, active control, or placebo. The aim of the study had to include a treatment goal of dose reduction or cessation of opioid medication.
  
  
  METHODS
  We sought data relating to prescribed opioid use, adverse events of opioid reduction, pain, and psychological and physical function.
  
  
  RESULTS
  Two studies provided information on 86 participants. One compared electroacupuncture with sham acupuncture for 20 minutes twice a week for six weeks; there was no difference between treatments. The other followed 11 weeks of cognitive behavioural therapy with either therapeutic interactive voice response through a computer for four months or usual treatment; the active group had a significant reduction in opioid use, while the usual care group had a significant increase.
  
  
  CONCLUSIONS
  Both included studies were at significant risk of bias because of their small size, together with other important issues, including blinding. Because of this risk and the paucity of relevant studies, no conclusions can be drawn regarding the effectiveness of interventions for opioid withdrawal in chronic non-cancer pain.
authors.affiliation: Pain Research and Nuffield Department of Clinical Neurosciences, University of Oxford, Churchill Hospital, Oxford, UK, OX3 7LE.
authors.forename: Jude
authors.initials: J
authors.lastname: Windmill
authors.forename: Emma
authors.initials: E
authors.lastname: Fisher
authors.forename: Christopher
authors.initials: C
authors.lastname: Eccleston
authors.forename: Sheena
authors.initials: S
authors.lastname: Derry
authors.forename: Cathy
authors.initials: C
authors.lastname: Stannard
authors.forename: Roger
authors.initials: R
authors.lastname: Knaggs
authors.forename: R Andrew
authors.initials: RA
authors.lastname: Moore
mesh_terms: D000701:Analgesics, Opioid / Q000008:administration & dosage*; D059350:Chronic Pain / Q000188:drug therapy / Q000209:etiology / Q000628:therapy*; D015928:Cognitive Behavioral Therapy / Q000379:methods*; D004361:Drug Tolerance; D015671:Electroacupuncture / Q000379:methods*; D006801:Humans; D064887:Observational Studies as Topic; D016032:Randomized Controlled Trials as Topic; D013813:Therapy, Computer-Assisted / Q000379:methods
chemical_list: D000701:Analgesics, Opioid