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Papers of the Week

Papers: 15 May 2021 - 21 May 2021


Human Studies

2021 May 10


A qualitative trajectory analysis of patients’ experiences tapering opioids for chronic pain.


McNeilage AG, Avery NS, Holliday S, Glare PA, Ashton-James CE
Pain. 2021 May 10.
PMID: 33990111.


Tapering opioids for chronic pain can be challenging for both patients and prescribers, both of whom may be unsure of what to expect in terms of pain, distress, activity interference, and withdrawal symptoms over the first few weeks and months of the taper. In order to better prepare clinicians to provide patient-centred tapering support, the current research used prospective longitudinal qualitative methods to capture individual-level variation in patients' experience over the first few months of a voluntary physician-guided taper. The research aimed to identify patterns in individuals' experience of tapering, and explore whether patient characteristics, readiness to taper, opioid-tapering self-efficacy, or psychosocial context were related to tapering trajectory. Twenty-one patients with chronic non-cancer pain commencing tapering of long-term opioid therapy were recruited from a metropolitan tertiary pain clinic (n = 13) and a regional primary care practice (n = 8). Semi-structured phone interviews were conducted a mean of 8 times per participant over a mean duration of 12 weeks (N = 173). Four opioid tapering trajectories were identified, which we characterised as thriving, resilient, surviving, and distressed. High and low readiness to taper were a defining characteristic of "thriving" and "distressed" trajectories, respectively. Life adversity was a prominent theme of "resilient" and "distressed" trajectories, with supportive relationships buffering the effects of adversity for those who followed a "resilient" trajectory. Discussion focuses on the implications of these findings for the preparation and support of patients with chronic pain who are commencing opioid tapering.