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Potential impact of abrupt opioid therapy discontinuation in the management of chronic pain: A pilot study on patient perspective

Joy Hao, MD, PhD, David Lucido, PhD, Ricardo A. Cruciani, MD, PhD

Abstract


Objectives: This survey highlights the perspective of patients with chronic pain when confronted with the possibility of abrupt opioid discontinuation.

Design: Anonymous and self-administered survey.

Setting: Pain Clinic in an urban academic hospital setting.

Participants: Patients with chronic pain of at least 6 months, and age 18 years or older.

Main outcome measures: The perceived impact of abrupt opioid discontinuation on mood, daily functioning, and potential for opioid misuse.

Results: When patients were asked how they would feel if told their opioids would be discontinued, the responses were neglected (scale mean, 7.1), angry (6.3), helpless (6.7), and upset (7.0) on a scale of 0-10. The majority predicted loss of independence in activities of daily living (scale mean, 7.5), inability to enjoy their lives (7.4), and inability to work (7.8). A group of 19 patients (11.6 percent) reported that they would obtain opioids from friends or family, and 7 (4.4 percent) would obtain them illegally. These patients reported higher scores of neglect, anger, suspicion, helplessness, and upset (p = 0.000-0.019) and were more likely to have previously obtained opioids illegally (p = 0.008-0.023). The most common nonopioid strategies tried by patients were lumbar epidural (71.5 percent), physical therapy (78.9 percent), and exercise (83.5 percent). The strategies considered to be effective as opioid replacement therapy were lumbar epidural (42.3 percent), exercise (43.2 percent), and massage (42.0 percent).

Conclusions: These data suggest that opioid therapy discontinuation is an emotionally distressing experience for most patients, and the transition to nonopioid treatments is a complex process that will require patient participation to achieve optimal care.


Keywords


opioid discontinuation, exit strategy, chronic pain

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References


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DOI: https://doi.org/10.5055/jom.2014.0187

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