Tapering opioids: a comprehensive qualitative review

Davis, Mellar P.; Digwood, Glen; Mehta, Zankhana; McPherson, Mary Lynn

doi:10.21037/apm.2019.12.10

Cited by 24 publications

(16 citation statements)

References 231 publications

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“…Reviews of interventions designed to support opioid tapering for CNCP generally report that inadequate evidence is available to guide primary care practitioners (PCPs) in their management of opioid reduction for patients experiencing CNCP 4,5,9,12,30,31 . Most of the studies that we identified were conducted in the US, in academic settings, Veteran Affairs clinics, or safety net clinics located in hospitals.…”

Section: Resultsmentioning

confidence: 99%

“…Across all the studies that we reviewed, PCPs reported serious concerns about the implications and safety of tapering for many patients. For PCPs, the work of deprescribing is daunting and time consuming, with many people in each practice needing tapering support, and about one‐quarter of them requiring complex multifaceted interventions 22,30 . Lack of flexibility and resources in the health care system hampers the ability of PCPs to be responsive to patients’ needs.…”

Section: Discussionmentioning

confidence: 99%

“…However, there is minimal evidence to support how best to undertake these conversations. Many attempts to taper are unsuccessful, and patients who succeed in tapering often report more than one experience of tapering 30 …”

Section: Discussionmentioning

confidence: 99%

“…High quality qualitative studies have provided insight into the complex contexts in which tapering occurs, patient and PCP experiences, and barriers and potential enablers for successful tapering. There is evidence to suggest that tapering can be achieved without increased levels of pain and loss of functional capacity, especially when tapering occurs slowly 16,19,30 . The biggest gap in evidence lies in evaluating which patients or tapering characteristics are associated with benefit or harm 5 .…”

Section: Discussionmentioning

confidence: 99%

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Beyond the black stump: rapid reviews of health research issues affecting regional, rural and remote Australia

Osborne¹,

Piper²,

Alston³

et al. 2020

Medical Journal of Australia

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Chapter 1: Retail initiatives to improve the healthiness of food environments in rural, regional and remote communities Objective: To synthesise the evidence for effectiveness of initiatives aimed at improving food retail environments and consumer dietary behaviour in rural, regional and remote populations in Australia and comparable countries, and to discuss the implications for future food environment initiatives for rural, regional and remote areas of Australia. Study design: Rapid review of articles published between January 2000 and May 2020. Data sources: We searched MEDLINE (EBSCOhost), Health and Society Database (Informit) and Rural and Remote Health Database (Informit), and included studies undertaken in rural food environment settings in Australia and other countries. Data synthesis: Twenty‐one articles met the inclusion criteria, including five conducted in Australia. Four of the Australian studies were conducted in very remote populations and in grocery stores, and one was conducted in regional Australia. All of the overseas studies were conducted in rural North America. All of them revealed a positive influence on food environment or consumer behaviour, and all were conducted in disadvantaged, rural communities. Positive outcomes were consistently revealed by studies of initiatives that focused on promotion and awareness of healthy foods and included co‐design to generate community ownership and branding. Conclusion: Initiatives aimed at improving rural food retail environments were effective and, when implemented in different rural settings, may encourage improvements in population diets. The paucity of studies over the past 20 years in Australia shows a need for more research into effective food retail environment initiatives, modelled on examples from overseas, with studies needed across all levels of remoteness in Australia. Several retail initiatives that were undertaken in rural North America could be replicated in rural Australia and could underpin future research. Chapter 2: Which interventions best support the health and wellbeing needs of rural populations experiencing natural disasters? Objective: To explore and evaluate health and social care interventions delivered to rural and remote communities experiencing natural disasters in Australia and other high income countries. Study design: We used systematic rapid review methods. First we identified a test set of citations and generated a frequency table of Medical Subject Headings (MeSH) to index articles. Then we used combinations of MeSH terms and keywords to search the MEDLINE (Ovid) database, and screened the titles and abstracts of the retrieved references. Data sources: We identified 1438 articles via database searches, and a further 62 articles via hand searching of key journals and reference lists. We also found four relevant grey literature resources. After removing duplicates and undertaking two stages of screening, we included 28 studies in a synthesis of qualitative evidence. Data synthesis: Four of us read and assesse...

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

Beyond the black stump: rapid reviews of health research issues affecting regional, rural and remote Australia

Osborne¹,

Piper²,

Alston³

et al. 2020

Medical Journal of Australia

View full text Add to dashboard Cite

show abstract

“…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]. However, the misapplication of 2016 opioid prescribing guidelines from the US Centers for Disease Control and Prevention (CDC) [16] has been cited as a significant concern and contributing factor for abrupt tapering or discontinuing opioids in patients who have been stable on such medication for years [43].…”

Section: Discussionmentioning

confidence: 99%

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

Agarwal¹,

Louw

Puentedura

2020

IJERPH

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We describe the case of a 75-year-old female with chronic low back pain (CLBP), on opioids for more than 15 years. She presented with an acute episode of nausea, vomiting, abdominal pain, and shortness of breath. After a complete work-up, it was concluded that her presenting symptoms were likely due to her high levels of CLBP and high dose opioids. At the time of intervention, her opioid dosage was between 50–90 MME (Morphine milligram equivalent) (Norco 8 × 7.5 mg/day + Fentanyl 12 mcg patch). She was subsequently seen by the physician for seven outpatient internal medicine appointments over nine months and received Pain Neuroscience Education (PNE) in conjunction with monitored tapering of opioids and other medication associated with her CLBP. This case report demonstrates how a physician might deliver PNE as a viable nonpharmacological treatment option for the tapering of long-term opioids for chronic pain.

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How Should Opioids Be Started and Titrated?

Ankuda,

Horton

2023

Evidence-Based Practice of Palliative Medicine

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Tapering opioids: a comprehensive qualitative review

Cited by 24 publications

References 231 publications

Beyond the black stump: rapid reviews of health research issues affecting regional, rural and remote Australia

Beyond the black stump: rapid reviews of health research issues affecting regional, rural and remote Australia

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

How Should Opioids Be Started and Titrated?

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