Inga Gruß1, Alison Firemark2, Meghan Mayhew3, Carmit K McMullen4, Lynn L DeBar5. 1. Center for Health Research, Kaiser Permanente Northwest, 3800 N. Interstate, Portland, OR 97227, United States. Electronic address: inga.gruss@kpchr.org. 2. Center for Health Research, Kaiser Permanente Northwest, 3800 N. Interstate, Portland, OR 97227, United States. Electronic address: alison.j.firemark@kpchr.org. 3. Center for Health Research, Kaiser Permanente Northwest, 3800 N. Interstate, Portland, OR 97227, United States. Electronic address: meghan.h.mayhew@kpchr.org. 4. Center for Health Research, Kaiser Permanente Northwest, 3800 N. Interstate, Portland, OR 97227, United States. Electronic address: carmit.mcmullen@kpchr.org. 5. Kaiser Permanente Washington Health Research Institute, 1730 Minor Ave, Suite 1600, Seattle, WA 98101-1466, United States. Electronic address: lynn.debar@kp.org.
Abstract
BACKGROUND: Opioid treatment for chronic pain has garnered heightened public attention and political pressure to control a devastating public health crisis in the United States (U.S.). Resulting policy changes, together with ongoing public and political attention, have pushed health care systems and providers to lower doses or deprescribe and taper patients off opioids. However, little attention has been paid to the impact of such practice changes on patients who had relied on opioid treatment to manage their chronic pain. The aim of this article is to explore experiences with opioid-related care under aggressive tapering efforts and concomitant heightened monitoring and institutional oversight among patients with chronic pain in an integrated delivery system through in-depth interviews. METHODS: We interviewed 97 patients with chronic pain who were assigned to the usual care arm of the Pain Program for Active Coping and Training (PPACT) study. These patients had been prescribed opioids as part of their treatment regimens and taken opioids closely monitored by their health care providers. We followed the framework method for coding and analysing transcripts using NVivo 12. RESULTS: The experiences of these patients during this period of change can be understood through three interconnected themes: (1) many patients taking opioids experience debilitating physical side effects; (2) navigating opioid treatment contributes to significant emotional distress among many patients with chronic pain and; (3) the quality of patients' relationship with their primary care provider can be negatively affected by negotiations regarding long-term opioid treatment for chronic pain. CONCLUSION: We highlight the importance of utilizing communication approaches that are patient-centered and include shared decision making during the tapering and/or deprescribing processes of opioids and ensuring alternative pain treatments are available to patients with chronic pain.
BACKGROUND: Opioid treatment for chronic pain has garnered heightened public attention and political pressure to control a devastating public health crisis in the United States (U.S.). Resulting policy changes, together with ongoing public and political attention, have pushed health care systems and providers to lower doses or deprescribe and taper patients off opioids. However, little attention has been paid to the impact of such practice changes on patients who had relied on opioid treatment to manage their chronic pain. The aim of this article is to explore experiences with opioid-related care under aggressive tapering efforts and concomitant heightened monitoring and institutional oversight among patients with chronic pain in an integrated delivery system through in-depth interviews. METHODS: We interviewed 97 patients with chronic pain who were assigned to the usual care arm of the Pain Program for Active Coping and Training (PPACT) study. These patients had been prescribed opioids as part of their treatment regimens and taken opioids closely monitored by their health care providers. We followed the framework method for coding and analysing transcripts using NVivo 12. RESULTS: The experiences of these patients during this period of change can be understood through three interconnected themes: (1) many patients taking opioids experience debilitating physical side effects; (2) navigating opioid treatment contributes to significant emotional distress among many patients with chronic pain and; (3) the quality of patients' relationship with their primary care provider can be negatively affected by negotiations regarding long-term opioid treatment for chronic pain. CONCLUSION: We highlight the importance of utilizing communication approaches that are patient-centered and include shared decision making during the tapering and/or deprescribing processes of opioids and ensuring alternative pain treatments are available to patients with chronic pain.
Authors: Jesse Jansen; Vasi Naganathan; Stacy M Carter; Andrew J McLachlan; Brooke Nickel; Les Irwig; Carissa Bonner; Jenny Doust; Jim Colvin; Aine Heaney; Robin Turner; Kirsten McCaffery Journal: BMJ Date: 2016-06-03
Authors: Helen Kinsman Hughes; Philip Todd Korthuis; Somnath Saha; Susan Eggly; Victoria Sharp; Jonathan Cohn; Richard Moore; Mary Catherine Beach Journal: Patient Educ Couns Date: 2015-01-03
Authors: Clarice Poirier; Marc O Martel; Mélanie Bérubé; Aline Boulanger; Céline Gélinas; Line Guénette; Anaïs Lacasse; David Lussier; Yannick Tousignant-Laflamme; M Gabrielle Pagé Journal: Can J Pain Date: 2020-03-02
Authors: Alison J Firemark; Jennifer L Schneider; Jennifer L Kuntz; Dea Papajorgji-Taylor; John F Dickerson; Lou Ann Thorsness; Katherine R Reese; Mark D Sullivan; Lynn L Debar; David H Smith Journal: Pain Med Date: 2021-05-21 Impact factor: 3.750