Scholars@Duke publication: Effectiveness of motivational interviewing plus cognitive behavioral therapy vs shared decision making for voluntary opioid tapering in patients with chronic pain: the INSPIRE randomized pragmatic trial.

Effectiveness of motivational interviewing plus cognitive behavioral therapy vs shared decision making for voluntary opioid tapering in patients with chronic pain: the INSPIRE randomized pragmatic trial.

Publication , Journal Article

McCormack, LA; Edlund, MJ; Thomas, SM; Wu, L-T; Chelminski, PR; Archer, KR; Wagner, LK; Hirsch, S; Thompson, JE; Dolor, RJ; Ives, TJ; Chang, S ...

Published in: Pain Med

August 1, 2025

Published version (DOI) Open Access Copy (Duke) Link to item

OBJECTIVE: To compare the effectiveness of motivational interviewing plus cognitive behavioral therapy vs shared decision making on change in daily dosage of prescribed opioids for individuals with chronic non-cancer pain. DESIGN: Pragmatic randomized trial. SETTING: Three health systems in the southeastern United States. SUBJECTS: Adults (N = 525) prescribed opioid therapy for chronic non-cancer pain. METHODS: Participants were randomized to Arm 1 (a motivational interviewing visit plus eight group sessions of cognitive behavioral therapy) or Arm 2 (shared decision making medical visits). The primary outcome was change in average daily opioid dosage from baseline to 12 months using prescribing data from health records. Secondary outcomes were self-reported pain interference and physical function. RESULTS: Both arms experienced small decreases in dosage at 12 months from baseline: Arm 1 -12 milligram morphine equivalents (95% confidence interval: -19 to -4); Arm 2 - 6 milligram morphine equivalents (95% confidence interval: -14 to 2). The mean difference between arms for change in dosage, at -6 milligram morphine equivalents (95% confidence interval: -17 to 5), was neither statistically significant nor clinically meaningful. Those in Arm 1 with a mental health diagnosis had a larger reduction in dosage (-22 milligram morphine equivalents, 95% confidence interval: -33 to -11) than those in Arm 1 without a mental health diagnosis and those in Arm 2 with a mental health diagnosis (interaction P = .10). No change from baseline occurred in pain interference or physical function for either arm. CONCLUSIONS: Additional strategies are needed to support individuals prescribed opioid therapy for chronic pain with pain management and dosage reduction. Clinicaltrials.gov registration: NCT03454555. Participant enrollment began on June 26, 2019. https://classic.clinicaltrials.gov/ct2/show/NCT.03454555. Trial sponsor: RTI International.