Time for change: an experimental investigation of chronic pain patients' emotional and attitudinal responses to simulated opioid-tapering advice

Ashton‐James, Claire E.; Chemke‐Dreyfus, Axel; Costa, Daniel; Glare, Paul

doi:10.1097/j.pain.0000000000001543

Cited by 7 publications

(2 citation statements)

References 30 publications

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“…In fact, the entire discussion about drug discontinuation can be problematic because when patients are prescribed an appropriate and clinically indicated medication and are satisfied with it, rarely is it ever taken away. Since fear of pain and loss of clinical support is often a paramount concern for these patients, it may be helpful if alternative pain control regimens are introduced early in the conversation [19]. Patients should be reassured that the clinical team will not abandon them during or after the transition.…”

Section: Shared Decision-makingmentioning

confidence: 99%

Stopping or Decreasing Opioid Therapy in Patients on Chronic Opioid Therapy

et al. 2019

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With the rising concerns about long-term opioid use, particularly in patients with chronic noncancer pain, more and more patients are being considered for decreased doses or discontinuation of opioid therapy. This is a challenging clinical situation for both patient and clinician and should be presented in a shared decision-making model so that the patient understands the risks of opioid therapy and how the therapy will be discontinued. The patient should be aware of the long-range plan and its milestones. It is imperative that alternate pain control treatments be made available to the patient early, and that the patient never feels abandoned by the healthcare team. There can be many barriers in shared decision-making and multiple discussions between patient and provider may be required. Opioid use should not be decreased sharply or discontinued abruptly, but should be gradually decremented in a process known as tapering. Tapering should be systematic and planned in advance with the patient knowing the steps. Slow tapers (over months) are more comfortable for the patients but may not always be appropriate. There is guidance for planning the taper and the patient should be closely monitored throughout this process. If withdrawal symptoms occur, they can be managed, for example, with lofexidine. Patients should get full support as they explore new pain control options. For patients who have opioid use disorder, addiction counseling may be appropriate. Navigating opioid discontinuation can be slow work, but optimal results occur when the healthcare team works together and respectfully with the patient.

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Section: Shared Decision-makingmentioning

confidence: 99%

Stopping or Decreasing Opioid Therapy in Patients on Chronic Opioid Therapy

et al. 2019

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“…Many patients with chronic pain are fearful of reducing or discontinuing opioids, 25,27,30 and some are highly resistant to the idea. 1,36 Qualitative studies indicate that patients are primarily concerned about worsening pain and functioning when their medications are reduced 25,27,30 and are pessimistic about their ability to manage their pain with nonopioid alternatives. 25 These concerns are not unwarranted.…”

Section: Introductionmentioning

confidence: 99%

A qualitative trajectory analysis of patients' experiences tapering opioids for chronic pain

McNeilage

Avery

Holliday

et al. 2021

Pain

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Tapering opioids for chronic pain can be challenging for both patients and prescribers, both of whom may be unsure of what to expect in terms of pain, distress, activity interference, and withdrawal symptoms over the first few weeks and months of the taper. To better prepare clinicians to provide patient-centred tapering support, the current research used prospective longitudinal qualitative methods to capture individual-level variation in patients' experience over the first few months of a voluntary physician-guided taper. The research aimed to identify patterns in individuals' experience of tapering and explore whether patient characteristics, readiness to taper, opioid tapering self-efficacy, or psychosocial context were related to tapering trajectory. Twenty-one patients with chronic noncancer pain commencing tapering of long-term opioid therapy were recruited from a metropolitan tertiary pain clinic (n 5 13) and a regional primary care practice (n 5 8). Semistructured phone interviews were conducted a mean of 8 times per participant over a mean duration of 12 weeks (N 5 173). Four opioid-tapering trajectories were identified, which we characterised as thriving, resilient, surviving, and distressed. High and low readiness to taper was a defining characteristic of thriving and distressed trajectories, respectively. Life adversity was a prominent theme of resilient and distressed trajectories, with supportive relationships buffering the effects of adversity for those who followed a resilient trajectory. Discussion focuses on the implications of these findings for the preparation and support of patients with chronic pain who are commencing opioid tapering.

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