ArticleSubstance abuse2018
The conundrum of opioid tapering in long-term opioid therapy for chronic pain: A commentary.
Article in Substance abuse, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 45 papers, 3 of them syntheses that pooled it.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
45 citing papers in PubMed, 3 syntheses or guidelines pooled it.
- Impact of treatment duration on the effectiveness of opioid analgesia: a systematic review and meta-analysis.The British journal of general practice : the journal of the Royal College of General Practitioners · 2026Pooled it
- CDC Clinical Practice Guideline for Prescribing Opioids for Pain - United States, 2022.MMWR. Recommendations and reports : Morbidity and mortality weekly report. Recommendations and reports · 2022Guideline
- Evaluation of Buprenorphine Rotation in Patients Receiving Long-term Opioids for Chronic Pain: A Systematic Review.JAMA network open · 2021Pooled it
- Adolescent prefrontal and amygdala molecular signatures of perinatal morphine versus buprenorphine exposure in mice.Neurotoxicology · 2026Article
- Patient Profiles of Buprenorphine Initiators in General Healthcare Settings: A Latent Class Approach.Journal of general internal medicine · 2026Article
- Article
- Opioid use patterns and persistent use after hemodialysis access surgery.Journal of vascular surgery · 2025Article
- A qualitative interview study exploring the experiences of pain specialists on prescribing opioids for chronic non-cancer pain.Scientific reports · 2025Article
- "The Fact [Is] That There Is No Easy Way". A Qualitative Study of the Experiences of Aotearoa New Zealand Clinicians with Opioid Tapering for Chronic Non-Cancer Pain.Journal of pain research · 2025Article
- Tapering and withdrawing opioids: guidance informed by fundamental principles to minimise withdrawal symptoms.Therapeutic advances in psychopharmacology · 2025Review
- Are opioids effective analgesics and is physiological opioid dependence benign? Revising current assumptions to effectively manage long-term opioid therapy and its deprescribing.British journal of clinical pharmacology · 2024Review
- Patient Perspectives on Mental Health and Pain Management Support Needed Versus Received During Opioid Deprescribing.The journal of pain · 2024Article
- Impact of Opioid Dose Reductions on Patient-Reported Mental Health and Suicide-Related Behavior and Relationship to Patient Choice in Tapering Decisions.The journal of pain · 2024Article
- Opioid tapering and mental health crisis in older adults.Pharmacoepidemiology and drug safety · 2024Article
- "A Profound, Abiding Hatred": An Analysis of Hermann Goering's Alleged Morphine Addiction.Cureus · 2023Review
- Variation in Clinical Characteristics and Longitudinal Outcomes in Individuals with Opioid Use Disorder Diagnosis Codes.Journal of general internal medicine · 2023Observational
- Primary care management of Long-Term opioid therapy.Annals of medicine · 2022Review
- Complex Persistent Opioid Dependence-an Opioid-induced Chronic Pain Syndrome.Current treatment options in oncology · 2022Review
- Approaches to opioid prescribing in cancer survivors: Lessons learned from the general literature.Cancer · 2022Article
- Two data-driven approaches to identifying the spectrum of problematic opioid use: A pilot study within a chronic pain cohort.International journal of medical informatics · 2021Article
Corrections and comments
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Authors and funding
3 authors.
Funding
Abstract
backgroundIn response to the opioid epidemic and new guidelines, many patients on high-dose long term opioid therapy (LTOT) for chronic pain are getting tapered off opioids. As a result, a unique clinical challenge is emerging: while many on LTOT have poor pain control, functional decline, psychiatric instability, aberrancies and misuse, these issues may often worsen with opioid tapering. Currently, a clear explanation and practical guidance on how to manage this perplexing clinical scenario is lacking.
methodsWe offer a commentary with our perspective on possible mechanisms involved in this clinical phenomena and offer practical management guidance, supported by available evidence.
resultsIt is not well recognized that allostatic opponent process involved in development of opioid dependence can cause worsening pain, functional status, sleep and psychiatric symptoms over time, and significant fluctuation of pain and other affective symptoms due to their bidirectional dynamic interaction with opioid dependence ('affective dynamism'). These elements of complex persistent dependence (CPD), the grey area between simple dependence and addiction, can lead to escalating and labile opioid need, often generating aberrant behaviors. Opioid tapering, a seemingly logical intervention in this situation, may lead to worsening of pain, function and psychiatric symptoms due to development of protracted abstinence syndrome. We offer practicing clinicians management principles and practical guidance focused on management of CPD in addition to chronic pain in these difficult clinical scenarios.
conclusionAwareness of the science of the neuroplasticity effects of repeated use of opioids is necessary to better manage these patients with complex challenges.
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