*4.4. Study Limitations*

Studies that increase understanding of the clinical features that promote LTOT cessation are timely, yet scant, thus making the present findings relevant, despite the following design limitations: the data for this study were gathered retrospectively from a moderatelysized treatment cohort of non-randomized, non-blinded patients, who were treated in a private practice setting, and demographic subject data is limited. The lack of a long-term follow-up of mood status is also a limitation, and this follow-up would be especially interesting here, as an affiliated study showed prolonged cessation of LTOT in the current group [30].

### **5. Conclusions**

This study found that improvements in indicators of quality of life, depression, pain interference, catastrophizing, and fear avoidance are associated with successful LTOT cessation in patients with chronic, non-cancer pain who participated in a multidisciplinary opioid cessation program that offered buprenorphine as a substitution. Further research is required to confirm the nature of this relationship. A better understanding of these potentially interdependent clinical phenomena may eventually help clarify and improve interventions for the cessation of LTOT in patients with CNCP.

**Author Contributions:** Conceptualization, M.J.S.; methodology, M.J.S., Z.C. and C.H.A.Y.; software, M.J.S., Z.C. and C.H.A.Y.; validation, C.H.A.Y.; formal analysis, M.J.S. and C.H.A.Y.; investigation, M.J.S. and Z.C.; resources, M.J.S., Z.C. and J.H.; data curation, M.J.S., Z.C. and C.H.A.Y.; writing original draft preparation, M.J.S. and J.H.; writing—review and editing, M.J.S., Z.C., C.H.A.Y. and J.H.; visualization, M.J.S. and C.H.A.Y.; supervision, M.J.S.; project administration, M.J.S. All authors have read and agreed to the published version of the manuscript.

**Funding:** The researchers analyzed data through the course of routine, clinical, program-related quality assurance measures while under the employ of the IPM Medical Group. This research received no external funding.

**Institutional Review Board Statement:** This study was reviewed by Solutions IRB and was determined to be exempt from full review, according to 45CFR46.104(d)(4): (4) Secondary Research Uses of Data or Specimens, on 17 March 2020.

**Informed Consent Statement:** The IRB declared that consent was not required for this retrospective review of de-identified data or for publication of that data. However, participants were apprised of the nature of the intended use of their anonymous data, and provided consent at the time of data collection.

**Data Availability Statement:** The de-identified data can be retrieved from the authors, upon request.

**Acknowledgments:** The authors thank Jessica Goza, NP; Kelly Rumrill, NP; Tatiana Hernandez, CCA; and Julie Ginsburg, LAc, for their teamwork and assistance, as well as William George, Jr., for his encouragement.

**Conflicts of Interest:** The authors declare no conflict of interest.

#### **References**


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