# Effect of opioid taper on pain responses in patients with chronic pain

> **NIH NIH R21** · UNIVERSITY OF PENNSYLVANIA · 2020 · $241,500

## Abstract

ABSTRACT
The United States is in the midst of an epidemic of prescription drug abuse. In 2016, 3.3 million Americans
aged 12 or older reported misusing a prescribed opioid in the past month, with 1.8 million meeting criteria for a
prescription opioid use disorder, and over 290,000 being young adults between the ages of 18 and 25.
According to the Centers for Disease Control and Prevention, of the 52,404 opioid overdose deaths that
occurred in 2015, almost one-quarter involved a prescription opioid, such that the number of people in the U.S.
who die each day from overdose of prescription opioids has quadrupled since 1999. This public health crisis
was fueled in part by the well-intended efforts of clinicians to better treat chronic pain. Opioid prescriptions
almost tripled between 1991 and 2011, and in 2016, clinicians wrote an estimated 215 million prescriptions for
these medications, making them highly available in the community reservoir. Yet, despite the growth in opioid
prescriptions, the use of opioids for treatment of chronic pain is not an evidence-based intervention. In fact, as
evaluation data accumulate, it is becoming clear that outcomes are often poorer for patients on opioid therapy,
and that counterintuitive functional improvements are appreciated when the medications are tapered. An oft-
cited but untested explanation for this finding is the phenomenon of opioid-induced hyperalgesia (OIH), a
theorized state of increased pain sensitivity secondary to ongoing opioid use. Unknown is the degree to which
OIH contributes to the chronic pain experience for patients, as is the degree to which opioid taper would
improve pain sensitivity. Proposed is an innovative observational pilot study designed to measure the effect of
opioid taper on experimental pain perception in patients with chronic pain, thereby providing a proof-of-concept
study of OIH, and an empirical foundation for evidence-based treatment in this patient population. Specifically,
in a well-characterized sample of chronic pain patients on high-dose opioid therapy (≥200mg morphine
equivalent dose[MED]/day), we will examine responses to experimental pain stimuli as they undergo a
prescribed opioid taper to a target dose of ≤90mg MED/day. Using both cold-pressor and quantitative sensory
testing pain induction techniques, evoked, spinal and supra-spinal pain responses will be measured at weekly
intervals over the course of the active taper, and once stabilized, at monthly intervals up to 12months. In
addition to characterizing patterns of pain perception over time, (1) functional outcomes related to opioid taper,
and (2) variables related to the patient (age, gender, ethnicity), chronic pain condition (duration, severity), and
opioid therapy (dose, potency, duration of use) will be evaluated as predictors of pain response and taper
outcomes. Acknowledging the significant health risks associated with opioid therapy for the patient and the
community, it is critical that clinicians ha...

## Key facts

- **NIH application ID:** 9859380
- **Project number:** 5R21DA046364-02
- **Recipient organization:** UNIVERSITY OF PENNSYLVANIA
- **Principal Investigator:** Peggy A Compton
- **Activity code:** R21 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2020
- **Award amount:** $241,500
- **Award type:** 5
- **Project period:** 2019-02-01 → 2021-07-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/9859380

## Citation

> US National Institutes of Health, RePORTER application 9859380, Effect of opioid taper on pain responses in patients with chronic pain (5R21DA046364-02). Retrieved via AI Analytics 2026-05-29 from https://api.ai-analytics.org/grant/nih/9859380. Licensed CC0.

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