Gradual dose reduction can effectively minimize opioids for pain management. A randomized clinical trial published in July 2026 in Annals of Internal Medicine evaluated three patient-centered approaches to tapering long-term opioid therapy among adults with chronic pain who did not have moderate or severe opioid use disorder. Participants worked collaboratively with their deprescribing clinician to develop individualized tapering plans and were randomized to tapering alone, tapering plus cognitive behavioral therapy (CBT), or tapering plus a chronic pain self-management program (CPSMP). This was a population with longstanding pain: 71% of participants had experienced chronic pain for at least 10 years, and 35% had lived with pain for 20 years or longer.
Participants began with gradual tapering plans averaging approximately 5% dose reductions per month, with reductions generally not exceeding 10% per month. Throughout the taper, patients received close clinical follow-up, could pause reductions when needed, and could increase their dose with clinician approval. Approximately half of participants reduced their opioid dose by at least 50% without worsening pain, while those who maintained their dose reported improved pain outcomes. Neither CBT nor CPSMP increased tapering success; however, CBT was associated with fewer opioid withdrawal symptoms, suggesting it may improve the tolerability of opioid reduction.
The results of the EMPOWER study reinforce the broader movement toward patient-centered deprescribing, where shared decision-making, individualized tapering strategies, close monitoring and ongoing clinical support are recognized as essential components of effective medication reduction.
Reference
Darnall, B. D., Perez, L., Kao, M. C., Lorig, K., Mardian, A. S., Flood, P., Pun, T., Hanson, E. R., Brose, W., Chen, C. A., Cheung, M., Colloca, L., De Bruyne, K., Edelson, N., Kim, E., McGovern, M., Moore, N., Nicholson, B. D., Porter, J., Poupore-King, H., Salmasi, V., Stieg, R. L., Sinjary, L. S., Xu, J., Hong, J., Tian, L., & Mackey, S. C. (2026). Patient-centered prescription opioid tapering methods: A randomized clinical trial. Annals of Internal Medicine. https://doi.org/10.7326/ANNALS-25-04784
