![]() First, we provide a concise review of opioid pharmacology including mechanisms of analgesia, tolerance, and acute withdrawal. This article has a chronic pain focus thus, the content is not intended to be applicable to individuals with opioid use disorder (OUD). The purpose of this review is to provide pragmatic information about opioid tapering in adults with chronic pain for use in daily clinical practice. This is important because knowledge gaps about opioid tapering may represent a critical barrier to delivering optimal and possibly life-sustaining care to people receiving long-term opioid therapy. Knowledge about opioid tapering is limited, however, in part because there are no validated protocols tailored to adults with chronic pain. Many clinical guidelines aimed at improving safety of long-term opioid therapy for chronic pain recommend discontinuing opioids under certain circumstances, including failure to meet treatment goals or development of problematic opioid use.
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