***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
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    Input: & NA ; In opioid‐dependent individuals with chronic pain , buprenorphine/naloxone may be an effective therapeutic option using adequate dose and paying attention to withdrawal symptoms and pain . & NA ; Few studies have examined abuse of prescription opioids among individuals with chronic pain under buprenorphine/naloxone ( Bup/Nx ) maintenance . The current 7‐week inpatient study assessed oral oxycodone self‐administration by patients with chronic pain who had a history of opioid abuse . Participants ( n = 25 ) were transitioned from their preadmission prescribed opioid to Bup/Nx . All of the participants were tested under each of the sublingual Bup/Nx maintenance doses ( 2/0.5 , 8/2 or 16/4 mg ) in r and om order . During each maintenance period , participants could self‐administer oxycodone orally ( 0 , 10 , 20 , 40 or 60 mg prescription opioids ) or receive money during laboratory sessions . Drug choice ( percentage ) was the primary dependent variable . Subjective ratings of clinical pain and withdrawal symptoms also were measured . Mann‐Whitney tests compared percentage of drug choice for each active oxycodone dose to placebo . Logistic regression analyses identified correlates of oxycodone preference , defined as 60 % or greater choice of oxycodone compared to money . Pain was significantly reduced while participants were maintained on Bup/Nx compared to preadmission ratings . No differences in percentage drug choice were observed between the active oxycodone doses and placebo under each Bup/Nx maintenance dose . However , factors associated with oxycodone preference were lower Bup/Nx maintenance dose , more withdrawal symptoms and more pain . These data suggest that Bup/Nx was effective in reducing pain and supplemental oxycodone use . Importantly , adequate management of pain and withdrawal symptoms by Bup/Nx may reduce oxycodone preference in this population BACKGROUND Opiates are no longer considered the best strategy for the long-term management of chronic pain . Yet , physicians have made many patients dependent on them , and these patients still request treatment . Complementary and alternative medicine ( CAM ) therapies have been shown to be effective , but are not widely available and are not often covered by insurance or available to the medically underserved . METHODS Group medical visits ( GMVs ) provided education about non-pharmacological methods for pain management and taught mindfulness techniques , movement , guided imagery , relaxation training , yoga , qigong , and t'ai chi .  Forty-two patients attending GMVs for at least six months were matched prospect ively with patients receiving conventional care .  RESULTS No one increased their dose of opiates . Seventeen people reduced their dose , and seven people stopped opiates . On a 10-point scale of pain intensity , reductions in pain ratings achieved statistical significance ( p = 0.001 ) . The average reduction was 0.19 ( 95 % confidence interval [ CI ] 0.12 - 0.60 ; p = 0.01 ) . The primary symptom improved on average by -0.42 ( 95 % CI -0.31 to -0.93 ; p = 0.02 ) on the My Medical Outcome Profile , 2nd version . Improvement in the quality -of-life rating was statistically significant ( p = 0.007 ) with a change of -1.42 ( 95 % CI = -0.59 to -1.62 ) . In conventional care , no patients reduced their opiate use , and 48.5 % increased their dose over the two years of the project . CONCLUSIONS GMVs that incorporated CAM therapies helped patients reduce opiate use . While some patients found other physicians to give them the opiates they desired , those who persisted in an environment of respect and acceptance significantly reduced opiate consumption compared with patients in conventional care . While resistant to CAM therapies initially , the majority of patients came to accept and to appreciate their usefulness . GMVs were useful for incorporating non-reimbursed CAM therapies into primary medical care Many patients with chronic pain have less than optimal therapeutic outcomes after prolonged treatment with opiate analgesics . Worsening of pain perception , functional capacity , and mood often result . Medical detoxification is often undertaken in this situation . Ninety-five consecutive patients ( 49 men and 46 women ; age range , 26 - 84 ) with chronic noncancer pain ( maldynia ) were referred by local pain clinics for detoxification from long-term opiate analgesic ( LTOA ) therapy .  All patients had failed treatment as manifest by increasing pain levels , worsening functional capacity , and , in 8 % , the emergence of opiate addiction . Length of prior LTOA therapy ranged from 1.5 to 27 years ( mean , 8.8 years ) . After a minimum of 12 hours of abstinence from all opiate analgesics , patients were given low doses of sublingual ( SL ) buprenorphine or buprenorphine/naloxone ( Reckitt Benckiser ) . Maintenance dosing was individualized to treat chronic pain . Daily SL dose of buprenorphine ranged from 4 to 16 mg ( mean , 8 mg ) in divided doses . Mean duration of treatment is 8.8 months ( range , 2.4 - 16.6 months ) . At clinic appointments , patients were assessed for pain reports , functional capacity , and mood inventory . Eighty-six percent of patients experienced moderate to substantial relief of pain accompanied by both improved mood and functioning . Patient and family satisfaction was robust . Only 6 patients discontinued therapy secondary to side effects and /or exacerbation of pain . In this open-label study , SL buprenorphine and buprenorphine/naloxone were well tolerated and safe and appeared to be effective in the treatment of chronic pain patients refractory to LTOA Objectives : The objective of this prospect i ve , open-label study was to determine the long-term effect of medicinal cannabis treatment on pain and functional outcomes in participants with treatment-resistant chronic pain . Patients and Methods : The primary outcome was the change in the pain symptom score on the S-TOPS ( Treatment Outcomes in Pain Survey — Short Form ) question naire at the 6-month follow-up in an intent-to-treat population . Secondary outcomes included the change in S-TOPS physical , social , and emotional disability scales , the pain severity , and pain interference on the Brief Pain Inventory , sleep problems , and the change in opioid consumption . Results : A total of 274 participants were approved for treatment ; complete baseline data were available for 206 ( intent-to-treat ) , and complete follow-up data for 176 participants . At follow-up , the pain symptom score improved from median 83.3 ( 95 % confidence interval [ CI ] , 79.2 - 87.5 ) to 75.0 ( 95 % CI , 70.8 - 79.2 ) ( P<0.001 ) . The pain severity score ( 7.50 [ 95 % CI , 6.75 - 7.75 ] to 6.25 [ 95 % CI , 5.75 - 6.75 ] ) and the pain interference score ( 8.14 [ 95 % CI , 7.28 - 8.43 ] to 6.71 [ 95 % CI , 6.14 - 7.14 ] ) improved ( both P<0.001 ) , together with most social and emotional disability scores . Opioid consumption at follow-up decreased by 44 % ( P<0.001 ) . Serious adverse effects led to treatment discontinuation in 2 participants . Discussion : The treatment of chronic pain with medicinal cannabis in this open-label , prospect i ve cohort result ed in improved pain and functional outcomes , and a significant reduction in opioid use . Results suggest long-term benefit of cannabis treatment in this group of patients , but the study ’s noncontrolled nature should be considered when extrapolating the results Background The Institute of Medicine report “ Relieving Pain in America ” recommends the promotion of patient self-management of pain for all people with pain . Given the high prevalence of chronic pain in the US , new strategies are needed to enhance access to cognitive behavioral therapy ( CBT ) and other evidence -based treatments design ed to facilitate self-management of chronic pain conditions . Although CBT is efficacious , many patients have limited or no access to CBT . Technology-assisted delivery of CBT may improve access while maintaining efficacy . Methods / Design We describe a r and omized non-inferiority trial of interactive voice response (IVR)-based CBT for patients with chronic low back pain . This intervention uses daily IVR monitoring and weekly pre-recorded therapist feedback , based on patient-reported information , to provide treatment for patients at home . A total of 230 patients with chronic low back pain are being identified from a single statewide health system serving US military veterans . Participants are r and omized to receive either ten weeks of in-person CBT or IVR-based CBT . The primary outcome is pain intensity as measured by the Numeric Rating Scale immediately post-treatment . Secondary outcomes include pain-related interference , emotional functioning , and quality of life measured immediately post treatment , and 6 and 9 months post recruitment . Exploratory objectives of the study are to examine : ( 1 ) potential mediators of impact on clinical outcomes ( treatment retention , self-reported skill practice ratings , IVR call adherence , and treatment satisfaction ) ; and ( 2 ) moderators of treatment engagement , adherence to therapist recommendations for pain coping skill practice , and effects on clinical outcomes . Discussion This non-inferiority trial may identify an alternative to re source intensive in-person CBT that allows many more patients to receive care while also increasing retention of those enrolled in the program . Trial registration Clinical Trials.gov : NCT01025752 . Registered 3 December 2009 OBJECTIVE Several studies have shown that exposure to opioids for short or long periods alters pain sensitivity . Little is known about changes in pain sensitivity during and after tapering of long-term prescribed opioid treatment in chronic low-back pain ( cLBP ) patients . DESIGN The goal of this prospect i ve longitudinal study was to investigate pain sensitivity in a homogeneous patient population ( cLBP patients only ) after tapering of long-term ( 17 months )  opioid use and to monitor the changes in pain sensitivity for 6 months . METHODS Pain sensitivity ( thermal sensation and thermal pain thresholds in low back and nondominant h and ) was measured by quantitative sensory testing ( QST ) at 1 day before ( T1 ) , 3 weeks after ( T2 ) , and 6 months after the start of opioid tapering ( T3 ) in 35 patients with both cLBP and opioid medication ( OP ) , 35 opioid-naïve cLBP patients ( ON ) , and 28 individuals with neither pain nor opioid intake ( HC ) . RESULTS Significant differences in heat pain thresholds were found among the three groups at all three time points ( T1 : P=0.001 , T2 : P=0.015 , T3 : P=0.008 ) , but not between the two patient groups . OP patients showed lower cold pain thresholds at T2 than ON patients and HC . At T3 , the heat pain thresholds of OP patients still remained lower than HC ( P=0.017 ) , while those of ON patients were normalized . CONCLUSIONS Our findings suggest that long-term use of opioids does not reduce pain sensitivity in cLBP patients ; opioid tapering may induce brief hyperalgesia that can be normalized over a longer period OBJECTIVE To assess benefits of mindfulness meditation and cognitive behavioral therapy (CBT)-based intervention for opioid-treated chronic low back pain ( CLBP ) . DESIGN 26-week parallel-arm pilot r and omized controlled trial ( Intervention and Usual Care versus Usual Care alone ) . SETTING Outpatient . SUBJECTS Adults with CLBP , prescribed ≥30 mg/day of morphine-equivalent dose ( MED ) for at least 3 months . METHODS The intervention comprised eight weekly group sessions ( meditation and CLBP-specific CBT components ) and 30 minutes/day , 6 days/week of at-home practice . Outcome measures were collected at baseline , 8 , and 26 weeks : primary -pain severity ( Brief Pain Inventory ) and function/disability ( Oswestry Disability Index ) ; secondary -pain acceptance , opioid dose , pain sensitivity to thermal stimuli , and serum pain-sensitive biomarkers ( Interferon-γ ; Tumor Necrosis Factor-α ; Interleukins 1ß and 6 ; C-reactive Protein ) . RESULTS Thirty-five ( 21 experimental , 14 control ) participants were enrolled and completed the study . They were 51.8 ± 9.7 years old , 80 % female , with severe CLBP-related disability ( 66.7 ± 11.4 ) , moderate pain severity ( 5.8 ± 1.4 ) , and taking 148.3 ± 129.2 mg/day of MED . Results of the intention-to-treat analysis showed that , compared with controls , the meditation-CBT group reduced pain severity ratings during the study ( P = 0.045 ) , with between-group difference in score change reaching 1 point at 26 weeks ( 95 % Confidence Interval : 0.2,1.9 ; Cohen 's d = 0.86 ) , and decreased pain sensitivity to thermal stimuli ( P < 0.05 ) , without adverse events . Exploratory analyses suggested a relationship between the extent of meditation practice and the magnitude of intervention benefits . CONCLUSIONS Meditation-CBT intervention reduced 
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However , some patients report improvements in function and quality of life after tapering ( 21 ) .
Characteristics of Studies Evaluating the Effectiveness of Strategies to Reduce or Discontinue LTOT for Chronic Pain