Patients’ Experience With Opioid Tapering

A Conceptual Model With Recommendations for Clinicians

Stephen G Henry, Debora A Paterniti, Bo Feng, Ana-Maria Iosif, Richard L Kravitz, Gary Weinberg, Penney Cowan, Susan Verba

Research output: Contribution to journalArticle

2 Citations (Scopus)

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 languageEnglish (US)
JournalJournal of Pain
DOIs
StateAccepted/In press - Jan 1 2018

Fingerprint

Opioid Analgesics
Focus Groups
Chronic Pain
Interviews
Neck Pain
Back Pain
Health Status
Fear
Primary Health Care
Communication
Guidelines

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 journalArticle

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