Introduction

Deprescribing is an important component of chronic pain management for all patients, regardless of analgesic efficacy. Deprescribing facilitates a greater focus on multidisciplinary care and self-management. It is also a useful strategy to test whether benefit is attributable to the analgesic.

Deprescribing should be considered when:

• an analgesic is ineffective after an adequate trial (see Reviewing analgesia efficacy for chronic noncancer pain)
• an analgesic causes intolerable adverse effects
• the patient achieves a self-management approach
• an analgesic has been used for longer than 12 weeks.

Paracetamol and NSAIDs can be stopped immediately. A slower approach is required for opioids, benzodiazepines and adjuvants.

Consider the duration of analgesic use when determining the rate of dose reduction; a slow approach is required in patients who have taken opioids, benzodiazepines or adjuvants for longer than 3 months. A faster approach may be appropriate in patients who have taken opioids, benzodiazepines or adjuvants for less than 3 months or if adverse effects are intolerable; this prevents analgesics being used longer than necessary while trying to deprescribe. Deprescribing can occur more rapidly in supportive environments (eg specialist pain management programs).

For children who have been taking opioids or adjuvants for longer than 2 weeks, seek specialist advice for a deprescribing schedule.