Opioid-Sparing Interventions in Acute and Chronic Pain: New Insights from Multicenter Trials

Session Title: Opioid-Sparing Interventions in Acute and Chronic Pain: New Insights from Multicenter Trials

Topic: CLINICAL SCIENCE

Description: Prescription opioid use and opioid tapering are associated with significant health risks. Up to 8% of surgical patients are at risk for developing problematic opioid use after minor and major surgery and thus effective opioid sparing strategies are needed. To minimize tapering risks in patients taking opioids long term, the US, Australia, Canada, and the United Kingdom national guidances recommend tapering methods that are flexible, patient-centered, and with psychological supports. Each country cited limited evidence from few single-site studies and called for stronger evidence on tapering. This multidisciplinary workshop presents results from recent multicenter opioid sparing randomized controlled trials (RCTs) in acute and chronic pain in the USA and Europe.

Professor Darnall will present results from the national EMPOWER multisite RCT which compared the effectiveness of patient-centered tapering methods for 562 adults with chronic pain taking prescription opioids long term (pain intensity, 6.2±1.9; and total MEDD, 125.1±242). Participants engaged in a patient-centered opioid taper with close monitoring and e-supports, and were randomized to either: (1) Taper Only, (2) Taper + cognitive behavioral therapy (pain-CBT), or (3) Taper + chronic pain self-management program (CPSMP). No serious study related adverse events were recorded. Taper Only met trial success thresholds and CBT and CPSMP did not significantly improve taper outcomes at 12 months. Veteran site and higher baseline taper readiness predicted taper success. Dr. Darnall will also present published results for an RCT showing that a digital pain relief skills intervention resulted in quicker opioid cessation after breast cancer surgery compared to controls.

Dr Grelz will discuss key findings from the "Tapering from prescribed opioids in patients with chronic non-cancer pain (TOPIO) trial". In this multicenter RCT, encompassing 140 patients, (pain intensity 7,2±1.7 and MEDD 90±124) participants were randomized to 1) four-month tapering intervention supported by a physician and nurse, or 2) waiting-list to intervention. Intention to treat revealed 66% of participants in the tapering group successfully halved their opioid dose, and 41% discontinued opioids completely (number needed to treat = 2). Treatment adherence with 86% completing the intervention. Adverse events led to discontinued tapering for 3 participants. Secondary outcomes—including pain intensity, pain-related cognitions, mental health, and quality of life—did not differ significantly between groups at the four-month follow-up.

Dr Andréll will present results from two multicenter RCTs: one evaluating an opioid-free perioperative care pathway for patients undergoing laparoscopic bariatric surgery, and another assessing transcutaneous electrical nerve stimulation (TENS) for postoperative pain following laparoscopic cholecystectomy. Findings are complemented by qualitative interview studies from participants in both trials as well as health care professionals’ experience of TENS for treatment of postoperative pain. Both the opioid-free perioperative care pathway and TENS are effective interventions for treatment of postoperative pain, reducing need of opioids in the post-anesthesia care unit, with no difference in pain relief compared to conventional opioid treatment. The patients desire alternatives to pharmacological treatment in postoperative care. TENS offers the patient the possibility to actively participate in their pain management, enhancing autonomy.

Interactive discussion will highlight challenges and opportunities for clinical implementation.

Speakers

Beth Darnall Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine
USA

Beth Darnall, PhD is Professor of Anesthesiology, Perioperative, and Pain Medicine at Stanford University School of Medicine and Director of the Stanford Pain Relief Innovations Lab. A psychologist-scientist, she leads NIH and PCORI-funded national studies on scalable behavioral analgesic interventions and patient-centered opioid reduction.
Her work centers on developing, investigating and disseminating solutions that offer more equitable access to pain relief for diverse and underserved populations with acute, chronic and post-surgical pain. She created Empowered Relief, a 1-session behavioral pain intervention that is being delivered in 31 countries and in 8 languages. She and colleagues recently completed a large, national, comparative effectiveness study that tested different types of opioid tapering strategies and long term outcomes.
Three times she has briefed the U.S. Congress and the FDA on patient-centered pain care and opioid stewardship. She has keynoted national pain society conferences in Australia, New Zealand, The Netherlands, Switzerland and the U.K. In 2018 she spoke on the psychology of pain relief at the World Economic Forum in Davos, Switzerland.
She is the author of 5 books for patients and clinicians on behavioral pain treatment, and is the 2026 President-Elect of the United States Association for the Study of Pain.

Paulin Andréll Department of Anaesthesiology and Intensive Care Medicine, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg
Sweden

Paulin Andréll, MD, PhD, is an Associate Professor and Senior Consultant in Pain Medicine at the Department of Anesthesiology, Intensive Care Medicine and Pain Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden, and at Sahlgrenska Academy, University of Gothenburg. She is also President of the Swedish Pain Society. Her mission is to advance pain research, education, interdisciplinary collaboration, and person-centred pain care nationally and internationally.

Dr Andréll is internationally recognised for her research on high-frequency, high-intensity transcutaneous electrical nerve stimulation (TENS) for the treatment of postoperative pain. Her studies have made substantial contributions to the evidence base for neuromodulation as an opioid-sparing treatment strategy in acute postoperative pain and have informed clinical practice and implementation initiatives.

She is co-founder of Gothenburg Pain Lab, a leading multidisciplinary clinical research group focused on opioid-free and opioid-sparing pain management. The lab aims to improve care for acute, chronic, and cancer-related pain through innovative, person-centred treatments, with a particular focus on neuromodulation techniques such as TENS and spinal cord stimulation (SCS), as well as opioid-free approaches in anaesthesia and intensive care.

Henrik Grelz Department of Clinical Sciences Malmö, Center for Primary Health Care Research, Lund University
Sweden

Medical Doctor 2005
Specialist in Family Medicine 2014
Specialist in Pain Medicine 2017
Entered PhD-studies in 2016 and ended 2026
PhD degree in May 2026
Permanent position as Head of the department, Pain rehabilitation at Skane University Hospital since 2023.

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