Background & Aims

Opioids are commonly prescribed for the management of chronic non-cancer pain. However, current evidence does not support their long-term use and people taking opioids may need support to reduce or stop their use.
The aims of the research were to inform better practice, pathways and service design to support people with chronic non-cancer pain to reduce or stop their opioid use and to address inequalities in access.
Specifically, the systematic literature review (SLR) for barriers and facilitators of tapering interventions aimed to identify strategies that will support patients, their carers and healthcare professionals to safely and effectively reduce or discontinue patient opioid use.

Methods

We undertook four SLRs of tapering interventions: (i) effectiveness; (ii) safety and acceptability; (iii) barriers and facilitators and (iv) inequalities. Searches included databases (MEDLINE, Embase, CENTRAL, PsycINFO), trial registries (EU-CTR, ISRCTN, ANZCTR, Clinical trials.gov), websites (NIHR-be part of research, NICE Evidence Search, HMIC, British Pain Society Members area) and repositories (Google Scholar, CORE.ac.uk) up to September 2022.
Records were independently assessed by two reviewers for inclusion using prespecified criteria including: (i) adults with chronic non-cancer pain, with (ii) prescription opioid use ?3 months, (iii) intervention(s) aiming to reduce or discontinue opioid use. Eligible studies were quality assessed and predefined data were extracted. Qualitative data were analysed by thematic synthesis and identified barriers and facilitators were mapped to two theoretical frameworks: Theoretical Domains Framework[1] and Levesque’s conceptual framework[2].

Results

Sixteen studies (10 qualitative studies, 5 mixed-methods and 1 quantitative study) were identified. Most studies (12/16) reported barriers and facilitators of tapering interventions generally and 4/16 studies reported barriers and facilitators of a specific tapering intervention; one study only reported barriers. 13/15 studies were of moderate to high quality, 2/15 studies had major limitations and one study was of low quality.
Eight barriers (including lack of patient knowledge and motivation, negative expectations and burden) and eight facilitators (including patient knowledge, ability to taper and patient-led treatment) were identified and were agreed to by our stakeholder panel. Care that recognises the complexity of tapering and is patient-centred may be more likely to achieve safe and effective opioid tapering. Patient and healthcare professional willingness to taper and the patient’s ability to maintain taper is essential for the successful opioid tapering.

Conclusions

The identified barriers and facilitators highlight the complexity of opioid tapering with the potential for multiple interdependent, behavioural, structural and contextual barriers to arise. A whole patient-centred systems approach that recognises that tapering is a dynamic, individualistic, intensive process will increase the likelihood of successful opioid tapering. The design and delivery of successful opioid tapering interventions requires careful consideration of individual-level factors.

References

1.Michie S, Johnston M, Abraham C, Lawton R, Parker D, Walker A, et al. Making psychological theory useful for implementing evidence based practice: a consensus approach. Qual Saf Health Care. 2005;14(1):26-33.
2.Levesque JF, Harris MF, Russell G. Patient-centred access to health care: conceptualising access at the interface of health systems and populations. Int J Equity Health. 2013;12:18.
3.Roger Chou, Judith A. Turner, Emily B. Devine, et al. The Effectiveness and Risks of Long-Term Opioid Therapy for Chronic Pain: A Systematic Review for a National Institutes of Health Pathways to Prevention Workshop. Ann Intern Med.2015;162:276-286. [Epub 17 February 2015].

Presenting Author

Rebecca Bresnahan

Poster Authors

Rebecca Bresnahan

PhD

University of Liverpool

Lead Author

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Ruaraidh Hill PhD

University of Liverpool

Lead Author

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Michelle Maden PhD

University of Liverpool

Lead Author

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Rui Duarte

Lead Author

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Sam Eldabe

The James Cook University Hospital, Middlesbrough, UK

Lead Author

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Su Golder

Lead Author

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Marty Chaplin

Lead Author

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Beth Shaw

Lead Author

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Katy Sutcliffe

Lead Author

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Adam Todd

Lead Author

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Katherine Edwards

Lead Author

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Janette Greenhalgh

Lead Author

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Juliet Hounsome

Lead Author

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Jack Trafford

Lead Author

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Nefyn Williams

Lead Author

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Topics

  • Treatment/Management: Pharmacology: Opioid