Mild asthma in adults and adolescents

Crawley, A. E.; Strautman, Kassy; Zimmermann, Lindsey; Ryan, Christine

doi:10.46747/cfp.6808595

Cited by 5 publications

(6 citation statements)

References 19 publications

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“…Health systems and clinicians must continue to develop and implement patient-centered approaches to pain management for patients with established long-term opioid therapy . Clinically recommended approaches include discussing patients’ experiences with both positive and negative associations of long-term opioid therapy and other pain management strategies, developing risk reduction plans and addiction-informed treatment strategies for patients with signs of OUD, and facilitating voluntary opioid tapering for patients who are interested in lowering their dosages …”

Section: Discussionmentioning

confidence: 99%

Comparative Effectiveness of Opioid Tapering or Abrupt Discontinuation vs No Dosage Change for Opioid Overdose or Suicide for Patients Receiving Stable Long-term Opioid Therapy

et al. 2022

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Key Points Question For patients receiving stable long-term opioid therapy compared with a stable opioid dosage, what is the association of opioid dosage tapering or abrupt discontinuation with opioid overdose or suicide? Findings In this comparative effectiveness study of 415 123 episodes of stable long-term opioid therapy among 199 836 individuals, opioid tapering was associated with a small absolute increase in opioid overdose or suicide compared with a stable opioid dosage. No significant difference in outcomes between abrupt discontinuation and stable opioid therapy was identified. Meaning These findings do not support opioid dosage tapering as a strategy to reduce harms for patients receiving stable long-term opioid therapy without evidence of misuse.

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Section: Discussionmentioning

confidence: 99%

Comparative Effectiveness of Opioid Tapering or Abrupt Discontinuation vs No Dosage Change for Opioid Overdose or Suicide for Patients Receiving Stable Long-term Opioid Therapy

et al. 2022

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“…35 If patients reveal a low readiness to taper, clinicians can respond using motivational interviewing techniques such as listening, asking, and informing to enable patients to identify barriers to change. 14,29 Motivational interviewing may also support patients along their tapering journey. A recent study found that patients with chronic pain who received weekly consultations with a physician assistant to discuss barriers and motivations for tapering (in addition to pain self-management strategies) were able to achieve lower daily doses of opioids without increased pain.…”

Section: Discussionmentioning

confidence: 99%

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

McNeilage

Avery

Holliday

et al. 2021

Pain

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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. 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 noncancer pain commencing tapering of long-term opioid therapy were recruited from a metropolitan tertiary pain clinic (n 5 13) and a regional primary care practice (n 5 8). Semistructured phone interviews were conducted a mean of 8 times per participant over a mean duration of 12 weeks (N 5 173). Four opioid-tapering trajectories were identified, which we characterised as thriving, resilient, surviving, and distressed. High and low readiness to taper was 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.

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“…Participants also received an educational DVD, relaxation CD, mindfulness CD, and distraction techniques. Additionally, participants had an individual, 1-hour consultation (based on motivational interviewing) with a nurse, 2 monitoring telephone calls (30 minutes each), and a face-to-face consultation (1 hour) . Nurses used a tapering app specifically designed for this trial that computed a standard opioid tapering plan consisting of a reduction of 10% of the baseline dose each week until 30% of the baseline dose was reached, then a reduction of 10% of the remaining dose per week (eTable 3 in Supplement 2).…”

Section: Methodsmentioning

confidence: 99%

“…Case studies illustrating successful opioid tapering and challenges were discussed. Participants also received an educational DVD, 12 Nurses used a tapering app specifically designed for this trial that computed a standard opioid tapering plan consisting of a reduction of 10% of the baseline dose each week until 30% of the baseline dose was reached, then a reduction of 10% of the remaining dose per week (eTable 3 in Supplement 2). The tapering program was individualized according to opioid preparation and individual circumstances.…”

Section: Key Pointsmentioning

confidence: 99%

Reducing Opioid Use for Chronic Pain With a Group-Based Intervention

Sandhu

Booth

Furlan

et al. 2023

JAMA

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ImportanceOpioid use for chronic nonmalignant pain can be harmful.ObjectiveTo test whether a multicomponent, group-based, self-management intervention reduced opioid use and improved pain-related disability compared with usual care.Design, Setting, and ParticipantsMulticentered, randomized clinical trial of 608 adults taking strong opioids (buprenorphine, dipipanone, morphine, diamorphine, fentanyl, hydromorphone, methadone, oxycodone, papaveretum, pentazocine, pethidine, tapentadol, and tramadol) to treat chronic nonmalignant pain. The study was conducted in 191 primary care centers in England between May 17, 2017, and January 30, 2019. Final follow-up occurred March 18, 2020.InterventionParticipants were randomized 1:1 to either usual care or 3-day–long group sessions that emphasized skill-based learning and education, supplemented by 1-on-1 support delivered by a nurse and lay person for 12 months.Main Outcomes and MeasuresThe 2 primary outcomes were Patient-Reported Outcomes Measurement Information System Pain Interference Short Form 8a (PROMIS-PI-SF-8a) score (T-score range, 40.7-77; 77 indicates worst pain interference; minimal clinically important difference, 3.5) and the proportion of participants who discontinued opioids at 12 months, measured by self-report.ResultsOf 608 participants randomized (mean age, 61 years; 362 female [60%]; median daily morphine equivalent dose, 46 mg [IQR, 25 to 79]), 440 (72%) completed 12-month follow-up. There was no statistically significant difference in PROMIS-PI-SF-8a scores between the 2 groups at 12-month follow-up (−4.1 in the intervention and −3.17 in the usual care groups; between-group difference: mean difference, −0.52 [95% CI, −1.94 to 0.89]; P = .15). At 12 months, opioid discontinuation occurred in 65 of 225 participants (29%) in the intervention group and 15 of 208 participants (7%) in the usual care group (odds ratio, 5.55 [95% CI, 2.80 to 10.99]; absolute difference, 21.7% [95% CI, 14.8% to 28.6%]; P &lt; .001). Serious adverse events occurred in 8% (25/305) of the participants in the intervention group and 5% (16/303) of the participants in the usual care group. The most common serious adverse events were gastrointestinal (2% in the intervention group and 0% in the usual care group) and locomotor/musculoskeletal (2% in the intervention group and 1% in the usual care group). Four people (1%) in the intervention group received additional medical care for possible or probable symptoms of opioid withdrawal (shortness of breath, hot flushes, fever and pain, small intestinal bleed, and an overdose suicide attempt).Conclusions and RelevanceIn people with chronic pain due to nonmalignant causes, compared with usual care, a group-based educational intervention that included group and individual support and skill-based learning significantly reduced patient-reported use of opioids, but had no effect on perceived pain interference with daily life activities.Trial Registrationisrctn.org Identifier: ISRCTN49470934

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Mild asthma in adults and adolescents

Cited by 5 publications

References 19 publications

Comparative Effectiveness of Opioid Tapering or Abrupt Discontinuation vs No Dosage Change for Opioid Overdose or Suicide for Patients Receiving Stable Long-term Opioid Therapy

Comparative Effectiveness of Opioid Tapering or Abrupt Discontinuation vs No Dosage Change for Opioid Overdose or Suicide for Patients Receiving Stable Long-term Opioid Therapy

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

Reducing Opioid Use for Chronic Pain With a Group-Based Intervention

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