OPIATE REDUCTION IN CHRONIC PAIN PATIENTS - A COMPARISON OF PATIENT-CONTROLLED REDUCTION AND STAFF CONTROLLED COCKTAIL METHODS

This study compares the effectiveness of two methods of opiate reducti on in 108 chronic pain patients during a 4 week inpatient pain managem ent programme, and at 1-month and 6-month follow-up. Patients chose ei ther the patient-controlled reduction (PCR) or cocktail reduction meth od, aiming to complete withdrawal by discharge. Use of opiates and oth er drugs was recorded, and psychological measures taken, at admission, at discharge, and at follow-ups. Patients who opted for the cocktail reduction method started at higher morphine equivalents (P < 0.001), w ere less confident in their ability to cope without medication (P < 0. 05), and rated their everyday activities as more disrupted by pain (P < 0.05). At discharge, 89% of the cocktail group were abstinent from o piates compared with 68% of the PCR group (P < 0.05). By 1-month follo w-up, the advantage of the cocktail method had disappeared, with no si gnificant differences between the two groups in mean opiate dose, nor in the proportion of abstinent patients. This was the result of a grea ter return to opiate use in the cocktail group, with abstinence rates remaining unchanged in the PCR group. By 6-month follow-up, abstinence rates for the groups were equivalent, with 55% of patients remaining off opiates. By this stage, however, non-abstinent cocktail group pati ents were taking significantly larger doses of opiates than PCR patien ts (P < 0.05), although in both groups, the dose was well below admiss ion level. Admission opiate dose level was the best predictor both of abstinence at discharge and of subsequent opiate dose level in non-abs tinent patients. This study demonstrates that both reduction methods c an produce substantial reduction in opiate use by severely impaired ch ronic pain patients with long medication histories.