Compass Opioid Stewardship 2026 Virtual Symposium-FREE NO CME-02-Top Articles from 2025-Weirner-Bradley-Handouts

02-Top Articles from 2025-Weirner-Bradley-Handouts

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This document summarizes “Top Articles from 2025” presented at the Compass Opioid Stewardship 2026 Conference, highlighting evidence to guide safer chronic pain care and opioid stewardship. It reviews 10 key studies spanning medications, nonpharmacologic therapies, lifestyle interventions, health-system tools, and opioid management.<br /><br />A BMJ Evidence-Based Medicine systematic review of 19 RCTs found tramadol provides statistically significant but clinically marginal pain reduction for chronic pain (mean difference 0.93/10, below the 1-point minimal clinically important difference) while increasing serious adverse events (OR 2.13), challenging the notion of tramadol as a “safer” opioid. A Lancet Rheumatology meta-analysis of 75 RCTs reported several non-surgical treatments yield sustained benefits for chronic low back pain at 12+ months, with the strongest support for cognitive behavioral therapy (CBT) and mindfulness improving pain, and some evidence that goal setting/needling reduce disability.<br /><br />Medication safety signals were emphasized: a large retrospective TriNetX cohort study associated repeated gabapentin prescribing in chronic low back pain with higher risk of dementia (RR 1.29) and mild cognitive impairment (RR 1.85), particularly in adults aged 18–64, with greater exposure linked to higher risk (association, not causation).<br /><br />System-level and access interventions showed promise: a cluster RCT in JAMA Internal Medicine found EHR-integrated clinical decision support increased naloxone prescribing and OUD treatment actions in primary care, though not downstream outcomes like overdoses. A large JAMA RCT demonstrated telehealth-delivered CBT and an online CBT program improved pain outcomes versus usual care, supporting scalable behavioral treatment.<br /><br />Lifestyle and complementary approaches were also reviewed: adding lifestyle coaching to physiotherapy produced small average disability improvements (larger among adherent participants); auricular acupressure improved pain/function in older adults with possible placebo contribution; greater walking volume (around 100+ minutes/day) was associated with lower chronic low back pain risk. An observational cohort suggested participation in a regulated medical cannabis program was associated with reduced opioid receipt over 18 months.<br /><br />Cross-cutting themes include modest medication benefits with meaningful risks, the value of multimodal nonpharmacologic care, the importance of reassessing long-term therapies, and the need for individualized, patient-centered opioid tapering when both continuation and discontinuation may be harmful.

Keywords

opioid stewardship

chronic pain management

tramadol safety

nonpharmacologic therapies

cognitive behavioral therapy (CBT)

mindfulness-based interventions

gabapentin cognitive risk

EHR clinical decision support

naloxone prescribing

telehealth CBT