Hopes and fears before opioid tapering: a quantitative and qualitative study of patients with chronic pain and long-term opioids

Abstract

Background: It is clear that the risks of opioids in chronic pain outweigh the benefits, creating a drive for clinicians to support patients taper and stop long-term opioids. However, it is not known how patients who have been taking these medicines for months or years feel about reducing them. Using quantitative and qualitative data, this study describes the psychological complexity of these patients and examines their hopes and fears before opioid reduction. Methods: Sixty patients attending the opioid clinic completed psychological and pain questionnaires, providing quantitative data, just before they commenced opioid tapering. They scored the severity of opioid side effects and completed a free text framework to express their beliefs about stopping or continuing opioids. A phenomenological approach was used to identify common qualitative themes. Results: Most patients were taking opioid doses above the UK recommended maximum dose and reported severe pain with high pain interference. Over 80% of patients described significant depression and 60% significant anxiety. Negative themes around stopping opioids were more common than positive ones, with 63% patients fearing increased pain. A quarter of patients referred to addiction and 16% feared withdrawal. Five patients hoped for a better quality of life; seven feared a worse one. Opioid side effects were common and severe. Conclusion: Patients with chronic pain taking long-term opioids demonstrate high psychological distress and low self-efficacy. Their concerns around opioid tapering relate to pain, quality of life and withdrawal. Identifying and addressing patients’ individual concerns should increase the likelihood of successful opioid tapering.