Experiences of people taking opioid medication for chronic non-malignant pain: a qualitative evidence synthesis using meta-ethnography

Abstract

ObjectiveTo review qualitative studies on the experience of taking opioid medication for chronic non-malignant pain (CNMP) or coming off them.DesignThis is a qualitative evidence synthesis using a seven-step approach from the methods of meta-ethnography.Data sources and eligibility criteriaWe searched selected databases—Medline, Embase, AMED, Cumulative Index to Nursing and Allied Health Literature, PsycINFO, Web of Science and Scopus (Science Citation Index and Social Science Citation Index)—for qualitative studies which provide patients’ views of taking opioid medication for CNMP or of coming off them (June 2017, updated September 2018).Data extraction and synthesisPapers were quality appraised using the Critical Appraisal Skills Programme tool, and the GRADE-CERQual (Grading of Recommendations Assessment, Development and Evaluation working group - Confidence in Evidence from Reviews of Qualitative research) guidelines were applied. We identified concepts and iteratively abstracted these concepts into a line of argument.ResultsWe screened 2994 unique citations and checked 153 full texts, and 31 met our review criteria. We identified five themes: (1) reluctant users with little choice; (2) understanding opioids: the good and the bad; (3) a therapeutic alliance: not always on the same page; (4) stigma: feeling scared and secretive but needing support; and (5) the challenge of tapering or withdrawal. A new overarching theme of ‘constantly balancing’ emerged from the data.ConclusionsPeople taking opioids were constantly balancing tensions, not always wanting to take opioids, and weighing the pros and cons of opioids but feeling they had no choice because of the pain. They frequently felt stigmatised, were not always ‘on the same page’ as their healthcare professional and felt changes in opioid use were often challenging.Trial registration number49470934; Pre-results.

The social threats of COVID-19 for people with chronic pain

“…Although this may be deemed necessary in the context of the pandemic due to heightened needs from patients for pain relief, clinicians and patients may not agree on opioid prescription/deprescription. 66 In addition, the individual assessment required to address the risks and benefits of opioid use and the monitoring of its use 85 may be complicated by a lack of access to face-to-face pain services.…”

Physician-Delivered Pain Neuroscience Education for Opioid Tapering: A Case Report

“…A recent systematic review involving qualitative evidence synthesis using meta-ethnography reported that people taking opioids for chronic non-cancer pain were constantly balancing tensions and not always wanting to take opioids [38]. Many weighed the pros and cons of taking opioids but felt that they had no choice because of their pain [38].…”

“…A recent systematic review involving qualitative evidence synthesis using meta-ethnography reported that people taking opioids for chronic non-cancer pain were constantly balancing tensions and not always wanting to take opioids [38]. Many weighed the pros and cons of taking opioids but felt that they had no choice because of their pain [38]. They frequently felt stigmatized and not always 'on the same page', as their prescribing physician and felt changes in opioid use were often very challenging [38].…”

“…Many weighed the pros and cons of taking opioids but felt that they had no choice because of their pain [38]. They frequently felt stigmatized and not always 'on the same page', as their prescribing physician and felt changes in opioid use were often very challenging [38]. Opioid stewardship has become a major concern among prescribing physicians, and there are a growing number of guidelines and protocols for tapering opioids [39][40][41][42].…”

Trends in Opioid Prescribing for Non-Cancer pain and Associated Resource Utilisation in Wales

“…Despite that, opioid analgesics continue to be frequently prescribed (Curtis et al 2019;Jani et al 2020). In the USA, opioid prescribing remains highly politicised and a source of conflict between different clinicians and patientgroups, with starkly drawn views on the place of the medicines in pain management (Matthias et al 2014;Mackey 2019;Schatman and Shapiro 2019;Matthias 2020;Nichols et al 2020).…”