Abstract
Clinical guidelines discourage prescribing opioids for chronic pain, but give minimal advice about how to discuss opioid tapering with patients. We conducted focus groups and interviews involving 21 adults with chronic back or neck pain in different stages of opioid tapering. Transcripts were qualitatively analyzed to characterize patients’ tapering experiences, build a conceptual model of these experiences, and identify strategies for promoting productive discussions of opioid tapering. Analyses revealed 3 major themes. First, owing to dynamic changes in patients’ social relationships, emotional state, and health status, patients’ pain and their perceived need for opioids fluctuate daily; this finding may conflict with recommendations to taper by a certain amount each month. Second, tapering requires substantial patient effort across multiple domains of patients’ everyday lives; patients discuss this effort superficially, if at all, with clinicians. Third, patients use a variety of strategies to manage the tapering process (eg, keeping an opioid stash, timing opioid consumption based on planned activities). Recommendations for promoting productive tapering discussions include understanding the social and emotional dynamics likely to impact patients’ tapering, addressing patient fears, focusing on patients’ best interests, providing anticipatory guidance about tapering, and developing an individualized tapering plan that can be adjusted based on patient response. Perspective: This study used interview and focus group data to characterize patients’ experiences with opioid tapering and identify communication strategies that are likely to foster productive, patient-centered discussions of opioid tapering. Findings will inform further research on tapering and help primary care clinicians to address this important, often challenging topic.
| Original language | English (US) |
|---|---|
| Journal | Journal of Pain |
| DOIs | |
| State | Accepted/In press - Jan 1 2018 |
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Keywords
- Chronic pain
- opioid analgesics
- opioid tapering
- patient–physician relations
- primary care
- qualitative research
- theoretical models
ASJC Scopus subject areas
- Neurology
- Clinical Neurology
- Anesthesiology and Pain Medicine
Cite this
Patients’ Experience With Opioid Tapering : A Conceptual Model With Recommendations for Clinicians. / Henry, Stephen G; Paterniti, Debora A; Feng, Bo; Iosif, Ana-Maria; Kravitz, Richard L; Weinberg, Gary; Cowan, Penney; Verba, Susan.
In: Journal of Pain, 01.01.2018.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - Patients’ Experience With Opioid Tapering
T2 - A Conceptual Model With Recommendations for Clinicians
AU - Henry, Stephen G
AU - Paterniti, Debora A
AU - Feng, Bo
AU - Iosif, Ana-Maria
AU - Kravitz, Richard L
AU - Weinberg, Gary
AU - Cowan, Penney
AU - Verba, Susan
PY - 2018/1/1
Y1 - 2018/1/1
N2 - Clinical guidelines discourage prescribing opioids for chronic pain, but give minimal advice about how to discuss opioid tapering with patients. We conducted focus groups and interviews involving 21 adults with chronic back or neck pain in different stages of opioid tapering. Transcripts were qualitatively analyzed to characterize patients’ tapering experiences, build a conceptual model of these experiences, and identify strategies for promoting productive discussions of opioid tapering. Analyses revealed 3 major themes. First, owing to dynamic changes in patients’ social relationships, emotional state, and health status, patients’ pain and their perceived need for opioids fluctuate daily; this finding may conflict with recommendations to taper by a certain amount each month. Second, tapering requires substantial patient effort across multiple domains of patients’ everyday lives; patients discuss this effort superficially, if at all, with clinicians. Third, patients use a variety of strategies to manage the tapering process (eg, keeping an opioid stash, timing opioid consumption based on planned activities). Recommendations for promoting productive tapering discussions include understanding the social and emotional dynamics likely to impact patients’ tapering, addressing patient fears, focusing on patients’ best interests, providing anticipatory guidance about tapering, and developing an individualized tapering plan that can be adjusted based on patient response. Perspective: This study used interview and focus group data to characterize patients’ experiences with opioid tapering and identify communication strategies that are likely to foster productive, patient-centered discussions of opioid tapering. Findings will inform further research on tapering and help primary care clinicians to address this important, often challenging topic.
AB - Clinical guidelines discourage prescribing opioids for chronic pain, but give minimal advice about how to discuss opioid tapering with patients. We conducted focus groups and interviews involving 21 adults with chronic back or neck pain in different stages of opioid tapering. Transcripts were qualitatively analyzed to characterize patients’ tapering experiences, build a conceptual model of these experiences, and identify strategies for promoting productive discussions of opioid tapering. Analyses revealed 3 major themes. First, owing to dynamic changes in patients’ social relationships, emotional state, and health status, patients’ pain and their perceived need for opioids fluctuate daily; this finding may conflict with recommendations to taper by a certain amount each month. Second, tapering requires substantial patient effort across multiple domains of patients’ everyday lives; patients discuss this effort superficially, if at all, with clinicians. Third, patients use a variety of strategies to manage the tapering process (eg, keeping an opioid stash, timing opioid consumption based on planned activities). Recommendations for promoting productive tapering discussions include understanding the social and emotional dynamics likely to impact patients’ tapering, addressing patient fears, focusing on patients’ best interests, providing anticipatory guidance about tapering, and developing an individualized tapering plan that can be adjusted based on patient response. Perspective: This study used interview and focus group data to characterize patients’ experiences with opioid tapering and identify communication strategies that are likely to foster productive, patient-centered discussions of opioid tapering. Findings will inform further research on tapering and help primary care clinicians to address this important, often challenging topic.
KW - Chronic pain
KW - opioid analgesics
KW - opioid tapering
KW - patient–physician relations
KW - primary care
KW - qualitative research
KW - theoretical models
UR - http://www.scopus.com/inward/record.url?scp=85055466561&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85055466561&partnerID=8YFLogxK
U2 - 10.1016/j.jpain.2018.09.001
DO - 10.1016/j.jpain.2018.09.001
M3 - Article
C2 - 30243859
AN - SCOPUS:85055466561
JO - Journal of Pain
JF - Journal of Pain
SN - 1526-5900
ER -