Grant: Project Grant

Chronic pain is a major health problem that affects approximately 20 % of the Canadian population. There has been an increase in the use of opioid medications for the management of chronic pain over the past decade in Canada, but this has been paralleled by escalating rates of opioid addiction and overdose deaths in these patients. Experts recommend tapering (i.e., lowering) opioid doses among high-dose opioid users to minimize risks of major health problems. Evidence, however, indicates that roughly 25-35 % of patients who are willing to taper opioids are unable to do so. To date, the factors that may influence opioid tapering outcomes have remained largely unexplored. The factors contributing to pain flares, opioid withdrawal symptoms, and opioid craving in patients with chronic pain who are undergoing opioid tapering have also yet to be explored. Aims: The main goal of the proposed research is to examine the psychological and neurobiological factors associated with opioid problems and tapering outcomes in patients with chronic pain on long-term opioid therapy who are undergoing gradual opioid dose reduction. Aim 1 will examine the contribution of psychological factors (i.e., negative affect, catastrophizing) and potential alterations in the brain to the experience of pain flares, opioid withdrawal symptoms, and opioid craving within the first 3 months of opioid tapering. Aim 2 will examine the degree to which these variables contribute to opioid tapering outcomes 3 months after initiation of opioid dose reduction. The proposed research will help better understand the psychological and neurobiological factors that may influence opioid tapering. Our findings might ultimately contribute to improving opioid tapering outcomes and minimizing opioid-related harms in patients with chronic pain.