mHealth Interventions to Support Prescription Opioid Tapering in Patients With Chronic Pain: Qualitative Study of Patients’ Perspectives

Abstract

Background Patients with chronic pain who are tapering prescription opioids report a need for greater support for coping with symptoms of pain and withdrawal. Mobile health (mHealth) technologies (SMS text messaging– or app-based) have the potential to provide patients with educational, emotional, and motivational support for opioid tapering beyond what is offered by their health care provider. However, it is not known whether patients with chronic pain who are tapering opioids would be willing or able to engage with technology-based support. Objective This study aims to examine patients’ use of mobile technologies in health care, interest in using mHealth support, preferences for the form and content of mHealth support, and potential barriers to and facilitators of engagement with mHealth support for opioid tapering. Methods A total of 21 patients (11 women and 10 men; age range 29-83 years) with chronic noncancer pain on long-term opioid therapy who had recently initiated a voluntary opioid taper were recruited from primary and tertiary care clinics in metropolitan and regional Australia for a larger study of patients’ experiences of opioid tapering. Participants had been taking prescription opioids for a mean duration of 13 (SD 9.6; range 0.25-30) years at the time of the study. Survey items characterized participants’ typical mobile phone use and level of interest in mobile technology–based support for opioid tapering. Semistructured interviews further explored patients’ use of mobile technologies and their interest in, preferences for, and perspectives on potential barriers to and facilitators of engagement with mHealth support for opioid tapering. Two researchers collaborated to conduct a thematic analysis of the interview data. Results All participants reported owning and using a mobile phone, and most (17/21, 81%) participants reported using mobile apps. The majority of participants expressed interest in SMS text messaging–based (17/21, 81%) and app-based (15/21, 71%) support for opioid tapering. Participants expected that messages delivering both informational and socioemotional support would be helpful. Participants expected that access to technology, mobile reception, internet connectivity, vision impairment, and low self-efficacy for using apps may be barriers to user engagement. Patients expected that continuity of care from their health care provider, flexible message dosing, responsivity, and familiarity with pain self-management strategies would increase user engagement. Conclusions The results of this study indicate that patients with chronic noncancer pain may be willing to engage with SMS text messaging–based and app-based mHealth interventions to support opioid tapering. However, the feasibility and acceptability of these interventions may depend on how patients’ preferences for functionality, content, and design are addressed.

Evaluating acceptability and feasibility of a mobile health intervention to improve self-efficacy in prescription opioid tapering in patients with chronic pain: protocol for a pilot randomised, single-blind, controlled trial

“…This pilot trial and development of the mHealth intervention was in response to research indicating that patients with chronic pain who are tapering opioid medications have a need and desire for support above and beyond that provided by their healthcare providers (ie, ‘out of office hours’). 28 34 The initial mHealth intervention prototype and trial design (procedures and measures) were developed in close collaboration with clinician-researchers with expertise in pain management and opioid tapering (AS, MF and BD) and a consumer representative (LD). The initial intervention design was then revised in response to feedback from panels of consumers and clinical experts (see Section 2.5.…”

“…Second, participants indicated that the content of text messages should be familiar, acting as a reminder of helpful concepts and coping strategies rather than being the primary source of information. 28 …”

“…Magee et al surveyed patients with chronic pain who had recently commenced a voluntary opioid taper to explore their attitudes towards using a digital health intervention (text messaging and mobile App) to support them with opioid dose reduction 28. This research revealed two key findings: First, the majority of participants felt that mobile phone-based interventions (specifically text messaging, SMS) would be useful as a means of providing support for opioid tapering 13 28.…”

“…Magee et al surveyed patients with chronic pain who had recently commenced a voluntary opioid taper to explore their attitudes towards using a digital health intervention (text messaging and mobile App) to support them with opioid dose reduction 28. This research revealed two key findings: First, the majority of participants felt that mobile phone-based interventions (specifically text messaging, SMS) would be useful as a means of providing support for opioid tapering 13 28. Participants indicated that text messages about the nature of chronic pain, pain self-management strategies, withdrawal symptoms and the benefits of tapering would provide them with instrumental, informational, motivational and emotional support.…”

“…Participants indicated that text messages about the nature of chronic pain, pain self-management strategies, withdrawal symptoms and the benefits of tapering would provide them with instrumental, informational, motivational and emotional support. Second, participants indicated that the content of text messages should be familiar, acting as a reminder of helpful concepts and coping strategies rather than being the primary source of information 28…”