720
Cochrane Corner
WHAT ARE THE MAIN RESULTS OF THE
COCHRANE REVIEW?
The review included 5 studies (278 participants). Parti-
cipants were primarily women (mean age 49.63 years,
SD 11.74) with different CNCP conditions. The studies
were too heterogeneous to pool data in a meta-analysis
and to judge the quality of evidence, so the results have
been summarised from each study qualitatively.
The review shows mixed results from the studies:
• Garland 2014 compared ’Mindfulness-Oriented Re-
covery Enhancement’ (MORE) with a support group
control, and found that participants in the MORE
group had lower desire for opioid consumption and
significantly lower self-reported opioid misuse at the
8-week post-treatment, but not at 3-month follow-up.
Naylor 2010 compared ’Therapeutic Interactive Voice
Response’ (TIVR) with usual treatment, following
cognitive behavioural therapy (CBT) delivered to all
participants for 11 weeks, and reported significantly
lower opioid use at 4-month and 8-month follow-up
in the TIVR group, compared to baseline. Sullivan
2017 compared opioid-tapering treatment to usual
care, and found a reduction in opioid consumption
in both groups at 22 weeks. There were no between-
group differences in the percent reduction of opioid
consumption from baseline at 22-week and 34-week
follow-up. Zheng 2008 compared real electroacu-
puncture (REA) to sham electroacupuncture (SEA),
and found significant reduction of opioid consump-
tion in both groups at 8 weeks after baseline, without
between-group differences, but after the 20-week
follow-up opioid consumption had increased and was
higher in the REA group, who maintained similar
levels to the 8-week follow-up. One study did not
measure this outcome.
• Three studies (Jamison 2010, Sullivan 2017, Zheng
2008) reported AEs related to the study. Instead,
Garland 2014 and Naylor 2010 did not observe
study-related AEs.
• There are mixed findings for pain intensity, psycho-
logical functioning, and physical functioning. Two
studies (Garland 2014 and Naylor 2010) reported a
reduction of pain intensity. Psychological functioning
improved in 3 studies (Jamison 2010, Naylor 2010 and
Zheng 2008). Physical functioning improved in 3 stud-
ies (Garland 2014, Naylor 2010 and Sullivan 2017).
WHAT DID THE AUTHORS CONCLUDE ON
THE EVIDENCE?
The authors concluded that there is insufficient evidence
about efficacy and safety of methods for reducing pres-
cribed opioid use in adults with CNCP. Few randomised
controlled trials (RCTs) investigated benefits and harms
www.medicaljournals.se/jrm
of psychological, pharmacological, or other types of in-
terventions for people with CNCP trying to reduce their
opioid consumption.
WHAT ARE THE IMPLICATIONS OF THE
COCHRANE EVIDENCE FOR PRACTICE IN
REHABILITATION?
This Cochrane Review aimed to investigate the effective-
ness of different methods designed to achieve reduction
or cessation of prescribed opioid use for the management
of CNCP in adults compared to controls.
The small number of RCTs, small number of partici-
pants, and heterogeneity that prevented pooling of data in
meta-analysis and evaluating quality of evidence, do not
allow making conclusions about utilization of tested inter-
ventions in practice. A larger body of evidence in this field
comes from observational studies, which were discussed
but not included for analysis in this Cochrane Review. A
three-week, outpatient, intensive, multidisciplinary pain
rehabilitation programme conducted at the Mayo Clinic
Pain Rehabilitation Center demonstrated large reductions
in medication use, particularly in use of opioids. From
a rehabilitation perspective, this could suggest that the
people who underwent intensive rehabilitation packages
may achieve a major reduction of opioids use. Therefore,
clinical trials of these interventions are needed to evaluate
the effectiveness of rehabilitation packages aimed to reduce
prescribed opioid use.
ACKNOWLEDGEMENTS.
The author thanks Cochrane Rehabilitation and Cochrane Pain,
Palliative and Supportive Care Review Group for reviewing the
contents of the Cochrane Corner.
The author have no conflicts of interest to declare.
REFERENCES
1. Eccleston C, Fisher E, Thomas KH, Hearn L, Derry S, Stan-
nard C, et al. Interventions for the reduction of prescribed
opioid use in chronic non-cancer pain. Cochrane Database
of Systematic Reviews 2017, Issue 11. Art. No.: CD010323.
DOI: 10.1002/14651858.CD010323.pub3.
2. Currow DC, Phillips J, Clark K. Using opioids in general
practice for chronic non-cancer pain: an overview of cur-
rent evidence. Med J Aust 2016; 204: 305-309.
3. Manchikanti L, Abdi S, Atluri S, Balog C, Benyamin R,
Boswell M, et al. American Society of Interventional
Pain Physicians (AISPP) guidelines for responsible opioid
prescribing in chronic non-cancer pain: part 1 – evidence
assessment. Pain Physician 2012; 15 (3 Suppl): S1–65.
4. Vowles KE, McEntee ML, Julnes PS, Frohe T, Ney JP, van
der Goes DN. Rates of opioid misuse, abuse, and addiction
in chronic pain: a systematic review and data synthesis.
Pain 2015; 156: 569–576.
5. Birnbaum HG, White AG, Schiller M, Waldman T, Cleveland
JM, Roland CL. Societal costs of prescription opioid abuse,
dependence, and misuse in the United States. Pain Med
2011; 12: 657–667.