Experiences and perspectives of adults on using opioids for pain management in the postoperative period

Abstract

BACKGROUND Opioids play an important role in peri-operative pain management. However, opioid use is challenging for healthcare practitioners and patients because of concerns related to opioid crises, addiction and side effects. OBJECTIVE This review aimed to identify and synthesise the existing evidence related to adults’ experiences of opioid use in postoperative pain management. DESIGN Systematic scoping review of qualitative studies. Inductive content analysis and the Theoretical Domains Framework (TDF) were applied to analyse and report the findings and to identify unexplored gaps in the literature. DATA SOURCES Ovid MEDLINE, PsycInfo, Embase, CINAHL (EBSCO), Cochrane Library and Google Scholar. ELIGIBILITY CRITERIA All qualitative and mixed-method studies, in English, that not only used a qualitative approach that explored adults’ opinions or concerns about opioids and/or opioid reduction, and adults’ experience related to opioid use for postoperative pain control, including satisfaction, but also aspects of overall quality of a person's life (physical, mental and social well being). RESULTS Ten studies were included; nine were qualitative (n = 9) and one used mixed methods. The studies were primarily conducted in Europe and North America. Concerns about opioid dependence, adverse effects, stigmatisation, gender roles, trust and shared decision-making between clinicians and patients appeared repeatedly throughout the studies. The TDF analysis showed that many peri-operative factors formed people's perceptions and experiences of opioids, driven by the following eight domains: Knowledge, Emotion, Beliefs about consequences, Beliefs about capabilities, Self-confidence, Environmental Context and Resources, Social influences and Decision Processes/Goals. Adults have diverse pain management goals, which can be categorised as proactive and positive goals, such as individualised pain management care, as well as avoidance goals, aimed at sidestepping issues such as addiction and opioid-related side effects. CONCLUSION It is desirable to understand the complexity of adults’ experiences of pain management especially with opioid use and to support adults in achieving their pain management goals by implementing an individualised approach, effective communication and patient–clinician relationships. However, there is a dearth of studies that examine patients’ experiences of postoperative opioid use and their involvement in opioid usage decision-making. A summary is provided regarding adults’ experiences of peri-operative opioid use, which may inform future researchers, healthcare providers and guideline development by considering these factors when improving patient care and experiences.