Patient-centered prescription opioid tapering in community outpatients with chronic pain: 2- to 3-year follow-up in a subset of patients

Ziadni, Maisa S.; Chen, Abby L.; Krishnamurthy, Parthasarathy; Flood, Pamela; Stieg, Richard L.; Darnall, Beth D.

doi:10.1097/pr9.0000000000000851

Cited by 8 publications

(14 citation statements)

References 9 publications

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“…A follow-up study on a subset of patients found that their dose reductions and pain stability were maintained 2 to 3 years later. 36 These findings suggest that this individualized consensual approach promotes successful opioid dose reduction.…”

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confidence: 94%

Clinical and neuroscience evidence supports the critical importance of patient expectations and agency in opioid tapering

Darnall

2021

Pain

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confidence: 94%

Clinical and neuroscience evidence supports the critical importance of patient expectations and agency in opioid tapering

Darnall

2021

Pain

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“…All except one (Chang et al, 2014 ) were offered in specialist pain service settings. Less structured information and education was provided in a pain service setting where the goal was to sequentially stabilise opioid dose then taper (Kurita et al, 2018 ) and patient‐centred ‘Prescription Opioid Tapering’ appointments, partnering with the prescribing physician (Darnall et al, 2018 ; Ziadni et al, 2020 ). A number of primary care settings also offered a more informal approach with physician‐ patient discussion of ethical principles and evidence‐based practice (Goodman et al, 2018 ), communication about opioid management for chronic pain (Matthias et al, 2017 ) and holistic care using self‐management principles through the South Gloucestershire pain review service (Scott et al, 2020 ).…”

Section: Resultsmentioning

confidence: 99%

“…Two studies reported statistically significant opioid reduction but noted a similar reduction was evident in the comparator group (Goodman et al, 2018 ; Sullivan et al, 2017 ) and a small number of studies showed statistically significant opioid reduction during the intervention period that was not maintained to the final study endpoint (Garland et al, 2014 ; Zheng et al, 2008 , 2019 ). Participants at specialist pain services started with higher opioid doses with the average starting dose reported as 193mg morphine equivalent dose (MED) (Gurino et al, 2018 ; Kurita et al, 2018 ; Naylor et al, 2010 ; Sullivan et al, 2017 ; Zheng et al, 2008 , 2019 ; Ziadni et al, 2020 ) in contrast to the average dose of 85mg MED reported in studies from primary care clinics (Doolin, 2017 ; Goodman et al, 2018 ; Mehl‐Madrona et al, 2016 ; Scott et al, 2020 ). Setting and delivery of interventions for opioid reduction.…”

Section: Resultsmentioning

confidence: 99%

“…Of the reviewed studies, data came from specialist pain services, (Darnell et al, 2018 ; Guarino et al, 2018 ; Jamison et al, 2010 ; Kurita et al, 2018 ; Naylor et al, 2010 ; Sullivan et al, 2017 ; Zheng et al, 2008 ; Ziadni et al, 2020 ) primary care clinics, (Goodman et al, 2018 ; Mathias et al, 2017 ; Mehl‐Madrona et al, 2016 ; Scott et al, 2020 ; Young & Heinzerling, 2017 ), a combination of both (Chang et al, 2014 ; Garland et al, 2014 ; Garland et al, 2019 ; Zheng et al, 2019 ) and one was conducted in a medical service of a correctional centre (Doolin, 2017 ). Structured psychological care was more likely to be undertaken in a specialist pain service (Garland et al, 2014 ; Garland et al, 2019 ; Jamison et al, 2010 ; Nilsen et al, 2010 ; Sullivan et al, 2017 ) as was the development of internet and telephone‐based techniques (Guarino et al, 2018 ; Naylor et al, 2010 ).…”

Section: Resultsmentioning

confidence: 99%

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A scoping review of outpatient interventions to support the reduction of prescription opioid medication for chronic non cancer pain

Nickerson

Lieschke

Rajappa

et al. 2022

Journal of Clinical Nursing

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Background Prescription opioid use is a global health issue. Previous systematic reviews have not identified that any specific intervention supports prescription opioid reduction effectively. In keeping with the nature of a scoping review, this review details an overview of the existing literature on this topic, with quality of evidence being discussed rather than formally analysed. Aim This review aimed to examine and describe outpatient interventions that support the reduction of prescription opioid medication for chronic non cancer pain. Eligibility criteria Abstracts were reviewed against the inclusion criteria of outpatient clinical interventions, for the purpose of prescription opioid dose reduction, offered to adults with CNCP. Sources of evidence Following a structured review approach an electronic database search, of Medline, Embase, Cochrane, Cinahl, and Proquest and grey literature was undertaken. Search results were screened by title for relevance. Charting methods Two reviewers adhering to the PRISMA‐ScR checklist charted and assessed studies for quality using Critical Appraisal Skills Programme checklist assessment tools. Extracted data were collated and synthesised for presentation as a tabular and narrative review. Results From the initial search of 5089 papers, 19 underwent full‐text review and quality appraisal. A variety of interventions were described to support reduction in prescription opioid use, however only one study of at least fair quality was able to demonstrate a demonstrated a statistically significant benefit in reducing measured opioid dose compared with a control group. Interventions were implemented in both specialist pain services and in primary care with multidisciplinary and interdisciplinary clinician care. Barriers and facilitators were observed in both settings. Conclusion and implications for clinical practice Further rigorous research needs to be conducted to conclusively answer the question of what outpatient interventions support opioid reduction in chronic non cancer pain. This scoping review is the first step of inquiry in the development of a nursing intervention to support reduction of prescription opioids.

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“…In an effort to reduce the harms associated with long-term opioid use, the Department of Defense (DoD)/Veterans Affair (VA) and the Centers for Disease Control (CDC) have published guidelines that recommend limiting prescriptions of opioids for the management of chronic pain to no more than 90 morphine milligram equivalents (MME) a day ( 1 – 3 ). While there is burgeoning evidence regarding the potential benefits of opioid tapering ( 4 – 7 ), debate persists about tapering methods, challenges, and potential harms, including increased risk of drug overdoses and mental health crises ( 8 – 10 ). In addition, there is limited empirical evidence to support best practices for successful opioid tapering in patients with chronic pain ( 11 , 12 ).…”

Section: Introductionmentioning

confidence: 99%

Attitudes Toward a Pre-authorized Concealed Opioid Taper: A Qualitative Analysis of Patient and Clinician Perspectives

et al. 2022

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Standard opioid tapers tend to be associated with increased patient anxiety and higher pain ratings. Pre-authorized concealed opioid reductions may minimize expectations such as fear of increased pain due to the reduction of opioids and, prolong analgesic benefits in experimental settings. We recently observed that patients and clinicians are open to concealed opioid tapering. However, little is known about the “why” behind their attitudes. Based on this lack of data, we analyzed qualitative responses to survey questions on patients' and clinicians' acceptance of a concealed opioid reduction for chronic pain. Seventy-four patients with a history of high dose opioid therapy and 49 clinicians completed a web-based questionnaire with open-ended questions examining responses to two hypothetical clinical trials comparing a concealed opioid reduction pre-authorized by patients vs. standard tapering. We used content analysis based on qualitative descriptive methodology to analyze comments from the patients and clinicians. Five themes were identified: informed consent; anxiety; safety; support; and ignorance is bliss, or not. These themes highlight the overall positive attitudes toward concealed opioid tapers. Our findings reinforce the importance of patient-centered care and are expected to inform the design of clinical trials from both the patient and clinician perspective. This qualitative study presents patients' and clinicians' attitudes toward hypothetical scenarios for a trial of pre-authorized reduction of opioids. The findings indicate positive attitudes and the relevance of engaging patients with effective decision-making processes.

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Patient-centered prescription opioid tapering in community outpatients with chronic pain: 2- to 3-year follow-up in a subset of patients

Abstract: Study findings reveal continued opioid reduction and enduring pain stability for a substantial fraction of patients, 2 to 3 years after a patient-centered voluntary opioid tapering program.

Cited by 8 publications

References 9 publications

Clinical and neuroscience evidence supports the critical importance of patient expectations and agency in opioid tapering

Clinical and neuroscience evidence supports the critical importance of patient expectations and agency in opioid tapering

A scoping review of outpatient interventions to support the reduction of prescription opioid medication for chronic non cancer pain

Attitudes Toward a Pre-authorized Concealed Opioid Taper: A Qualitative Analysis of Patient and Clinician Perspectives

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