Opioid Resource Center
Opioid Resource Center
November 28, 2018
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Effective, patient-centered discussions improve opioid tapering outcomes

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Cultivating effective discussions that were focused on the patient were likely to improve opioid tapering outcomes, according to research recently published in the Journal of Pain.

“Clinical guidelines provide general recommendations about opioid tapering rates (eg, 10% to 20% dose reduction every 2 to 4 weeks) but offer few concrete suggestions for how to discuss tapering with patients; CDC guidelines merely advise clinicians to ‘work with patients to taper opioids.’ There is thus a need to identify specific strategies for negotiating opioid tapering plans that facilitate patient-centered care and reduce mutual frustration,” Stephen G. Henry, MD, MSc, division of general medicine, geriatrics, and bioethics at the University of California, Davis and colleagues wrote.

Three major themes emerged from focus groups and/or interviews researchers conducted with 21 adults (mean age, 58.2 years; 10 male) with chronic neck or back pain and in various stages of tapering:

  • Ever-changing states of health, emotions and social relationships impact the sense of how much a patient thinks they need opioids are needed daily.
  • Tapering requires “substantial patient effort” across many components of a patient’s everyday life but the effort is rarely discussed in-depth with his or her clinician.
  • Managing the tapering process involves a varied range of strategies (eg, timing opioid consumption based on planned activities, having an opioid stash).

Henry and colleagues came up with the following guidelines based on these themes:

  • Identify the health, emotional and social factors that will impact patients’ tapering.
  • Suggest tapering only when it is in the patient’s best interest.
  • Discuss patient fears about tapering, including fears of abandonment.
  • Inform patients about what to expect when tapering and help them ascertain strategies to manage tapering.
  • Create an individualized tapering plan with provisions for making adjustments based on patient’s response.

Researchers also wrote their study was the first to record the substantial amount of physical, mental and emotional effort most patients must be willing to make during tapering, and that much of this effort is not discussed with clinicians.

“Additional research is needed before these strategies can be considered ‘best practices’ but these strategies should be helpful for clinicians given widespread clinical and institutional pressures to taper patients off long-term opioids and the lack of empirically-based advice for how to negotiate tapering with patients,” Henry and colleagues wrote.

“While not definitive, the clinical recommendations presented here can inform the design of interventions and communication training programs aimed at improving tapering outcomes by fostering effective, patient-centered discussions,” they added. – by Janel Miller

Disclosures: The authors report no relevant financial disclosures.