A scoping review of outpatient interventions to support the reduction of prescription opioid medication for chronic non cancer pain.
Kathie Nickerson, Gena Lieschke, Hema Rajappa and 2 others
PMID 35132707WHAT IT FOUND
No outpatient intervention was proven to reduce prescription opioids in chronic non-cancer pain.
The review found 19 small, mixed-quality studies; many reported dose reductions, but only half had a control or comparator group.
Key findings
01The review included 19 studies of outpatient interventions for adults with chronic non-cancer pain who were taking prescription opioids.
02Of 17 quantitative studies, nine reported a statistically significant opioid reduction, but not all had control groups. Two studies found significant reductions that were also seen in comparator groups, and some reductions were not maintained.
03The evidence was too small and mixed to identify an effective intervention: sample sizes were low, study quality varied, and gaps remained.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
This is a scoping review, not a trial or meta-analysis, so it cannot show that any intervention works. The included studies were small, with sample sizes between 10 and 115 participants. Study quality was moderate to low, and none of the randomised trials was rated better than fair. Many studies did not use a control or comparator group, and several relied on self-reported opioid use. Interventions and settings varied widely, so results cannot be combined into a clear recommendation. Most studies were done in large cities, mainly in the United States, so rural and non-US contexts are not well represented. Consumer consultation was not done, and cost, training, and implementation resources were not considered.
Declared interests
The review authors declared no competing interests. One included study had industry funding from Endo Pharmaceuticals.
The easy way to misread this
Do not read the reported opioid reductions as proof that an intervention works. The review included 19 small, mixed-quality studies, many without controls, and it did not identify a proven outpatient approach.