SynthesisPloS one2020
Multidisciplinary care for opioid dose reduction in patients with chronic non-cancer pain: A systematic realist review.
Synthesis in PloS one, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 14 papers, 1 of them a synthesis that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
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
14 citing papers in PubMed, 1 synthesis or guideline pooled it.
- Pooled it
- Care Models to Improve Pain and Reduce Opioids Among Patients Prescribed Long-Term Opioid Therapy: The VOICE Randomized Clinical Trial.JAMA internal medicine · 2025Trial
- Impact of chiropractic care on opioid use for noncancer spine pain: systematic review and meta-analysis.Pain reports · 2026Review
- Incorporating Patient and Provider Voices into the Veterans Pain Care Organizational Improvement Comparative Effectiveness Study: Informing Future Implementation.Journal of general internal medicine · 2025Article
- Unsupervised machine learning identifies opioid taper reversal patterns in a longitudinal cohort (2008-2018).PLOS digital health · 2025Article
- Pharmacological Strategies to Decrease Long-Term Prescription Opioid Use: A Systematic Review.Journal of clinical medicine · 2024Review
- Article
- Patients' perspectives on tapering programmes for prescription opioid use disorder: a qualitative study.BMJ open · 2023Article
- Article
- A scoping review of outpatient interventions to support the reduction of prescription opioid medication for chronic non cancer pain.Journal of clinical nursing · 2022Article
- The impact of introducing multidisciplinary care assessments on access to rheumatology care in British Columbia: an interrupted time series analysis.BMC health services research · 2022Article
- Evaluations of Continuing Health Provider Education Focused on Opioid Prescribing: A Scoping Review.Academic medicine : journal of the Association of American Medical Colleges · 2022Article
- Chronic Pain and Opioid Prescribing: Three Ways for Navigating Complexity at the Clinical‒Population Health Interface.American journal of public health · 2022Article
- Time series-based bibliometric analysis of a systematic review of multidisciplinary care for opioid dose reduction: exploring the origins of the North American opioid crisis.Scientometrics · 2021Article
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
16 authors.
Funding
Abstract
contextOpioid related deaths are at epidemic levels in many developed nations globally. Concerns about the contribution of prescribed opioids, and particularly high-dose opioids, continue to mount as do initiatives to reduce prescribing. Evidence around opioid tapering, which can be challenging and potentially hazardous, is not well developed. A recent national guideline has recognized this and recommended referral to multidisciplinary care for challenging cases of opioid tapering. However, multidisciplinary care for opioid tapering is not well understood or defined.
objectiveIdentify the existing literature on any multidisciplinary care programs that evaluate impact on opioid use, synthesize how these programs work and clarify whom they benefit. STUDY
designSystematic rapid realist review. DATASET: Bibliographic databases (MEDLINE, EMBASE, CINAHL, PsycINFO, Cochrane Library), grey literature, reference hand search and formal expert consultation.
results95 studies were identified. 75% of the programs were from the United States and the majority (n = 62) were published after 2000. A minority (n = 23) of programs reported on >12 month opioid use outcomes. There were three necessary but insufficient mechanisms common to all programs: pain relief, behavior change and active medication management. Programs that did not include a combination of all three mechanisms did not result in opioid dose reductions. A concerning 20-40% of subjects resumed opioid use within one year of program completion.
conclusionsProviding alternative analgesia is insufficient for reducing opioid doses. Even high quality primary care multidisciplinary care programs do not reduce prescribed opioid use unless there is active medication management accomplished by changing the primary opioid prescriber. Rates of return to use of opioids from these programs are very concerning in the current context of a highly potent and lethal street drug supply. This contextual factor may be powerful enough to undermine the modest benefits of opioid dose reduction via multidisciplinary care.
Indexed as
Identifiers
What OpenQuestion holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.