The Journal of Pain Summary
Highlight from The Journal of Pain (Volume 20, No. 2, February 2019)
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
Clinical guidelines discourage prescribing opioids for chronic pain but give minimal advice about how to discuss opioid tapering with patients. This study used interview and focus group data to characterize patients' experiences with opioid tapering and identify communication strategies that may foster discussions of opioid tapering.
Researchers from the University of California, Davis; Sonoma State University; and the American Chronic Pain Association collected information from 21 adults with chronic back or neck pain in various stages of opioid tapering. Qualitative analysis was used to characterize patient experiences, and a conceptual model was built based on this input.
These authors report that the effort needed to taper involves managing opioids, managing pain, managing side effects and withdrawal symptoms, managing patient identity, and managing emotions. Most patients already worked hard to manage pain and opioids prior to tapering; tapering required patients to try new and different strategies and involved considerable energy in order to adjust habits and maintain functionality. Nearly all patients reported that managing opioids became more difficult as tapering progressed.
Based on the findings and conceptual model that resulted, the authors have recommended several strategies for primary care clinicians: identify the social, emotional, and health factors that will impact patients’ tapering; tell patients what to expect when tapering and help them identify strategies to manage tapering; and develop an individualized tapering plan with provisions for making adjustments based on patient’s response.