A patient-centred approach to reducing opioid painkillers can help people with chronic pain safely cut their medication without increasing pain, according to a new study published in the Annals of Internal Medicine.

Researchers found that when patients were allowed to gradually reduce their opioid doses at their own pace, in close consultation with their doctors, nearly half successfully cut their medication by at least 50% or maintained a lower dose while experiencing significantly less pain after one year.

The study, led by Dr. Beth Darnall, Professor of Anesthesiology, Perioperative and Pain Medicine at Stanford University, included more than 500 adults living with chronic pain for at least six months. All participants had been taking prescription opioid painkillers for a minimum of three months, and none had an opioid addiction.

Many participants had been using opioids for much longer, with an average treatment duration of 12.4 years. Most wanted to reduce their dependence on the medicines and worked closely with their healthcare providers to identify the lowest dose that still provided adequate pain relief.

Under the Stanford programme, opioid doses were reduced gradually by no more than 10% each month. Patients were also free to pause the tapering process whenever they wished after discussing it with their doctors, ensuring they remained in control of their treatment.

After 12 months, around half of the participants achieved what researchers described as a successful outcome—either reducing their opioid dose by at least half without worsening pain or maintaining a lower dose while reporting significant improvements in pain levels.

Dr. Darnall said the findings should reassure patients who fear that reducing opioids will inevitably make their pain worse. She explained that giving patients control over the tapering process helped reduce anxiety and made it easier for them to continue lowering their medication safely.

The findings support current recommendations from the U.S. Centers for Disease Control and Prevention (CDC), which advocate a personalised, patient-driven approach to opioid tapering for chronic pain.

Researchers noted that earlier opioid reduction strategies often involved rapid or involuntary dose reductions, particularly following the CDC's 2016 prescribing guidance. Such abrupt tapering has been linked to severe withdrawal symptoms, increased risk of illicit drug use, mental health crises and even suicide in some patients.

Dr. Darnall said the study highlights that reducing opioids too quickly can create new health risks, stressing that opioid tapering should be gradual, carefully monitored and tailored to each patient's needs.

The researchers also evaluated whether additional support, including cognitive behavioural therapy (CBT) or peer-led chronic pain self-management programmes, improved tapering success. While these interventions did not significantly increase the number of successful dose reductions, CBT appeared to ease opioid withdrawal symptoms.

The team hopes the findings will help guide millions of people living with chronic pain who wish to reduce their reliance on opioid medicines. Previous research by Stanford University found that nearly seven in ten patients prescribed opioids had unsuccessfully attempted to reduce their medication on their own.

The researchers emphasised that the study does not apply to people with opioid addiction and that any reduction in opioid medication should always be undertaken under medical supervision.