Cessation of Long-term Opioid Therapy in Chronic Pain Patients

Inclusion Criteria:

* Male or Female, age above 18.
* Chronic non-cancer pain (pain for 6 or more months, current pain not attributed to a cancerous disease).
* Referrals to the Massachusetts General Hospital (MGH) Center for Pain Medicine for opioid taper.
* Chronic (more than 3 months) prescription of morphine, oxycodone, hydrocodone, hydromorphone, codeine or any formulation of these medications.
* Morphine dose equivalent of 60 mg or above.
* Opioid treatment has to be stable (plus or minus20%) over the last 3 months.
* Meeting Substance Abuse and Mental Health Services Administration (SAMHSA) criteria for exit from chronic opioid therapy
* Willingness to taper and participate in treatment as randomized (including cognitive workshop sessions), able to meet the protocol follow-up schedule and activities
* Agreement to undergo random urine toxicology assays, which will be recommended to prescribing physician during study.
* Agreement to sign an opioid contract, as recommended to prescribing physician.
* Informed consent to study (IRB approved informed Consent form).
* English Language Literacy.

Exclusion Criteria:

* Methadone, suboxone or fentanyl patch: the tapering with these opioids would not be comparable to the other patients. As enrolment will be open during about 12 months, if a patient was motivated to participate in the study, they could be referred to the pain clinic for advice on a switch to a medication that could allow inclusion. They would, 3 months after this switch, become eligible for the study.
* Pregnancy.
* History of epilepsy and drug-induced seizures.
* Proof of current diversion of drugs or recent substance related legal problems (e.g. buying/selling on the streets).
* Concurrent use of illicit drugs and narcotics (urine toxicology), active diagnosis of substance abuse or dependence disorder within last 3 months.
* Absence of the prescribed drug in the urine toxicology
* Refusal of taper or dose reduction trial.
* Preference for suboxone or related treatments.
* Severe psychiatric condition and/or cognitive deficits limiting patient's ability to participate
* Involved in concurrent opioid management for an acute pain condition.
* Current suicidal ideation.
* Severe and unstable medical illness including cardiovascular, hepatic, renal, respiratory, endocrine, neurological or hematological disease.
* General conditions that would impede participation in a group intervention, as assessed by evaluating physician (e.g. cognitive impairment, tendencies towards physical aggression).