Attitudes of chronic pain patients on long-term opioid therapy toward opioid tapering

AbstractThe chronic pain and opioid addiction epidemics interact with each other, potentially exacerbating each respective condition. Despite having modest efficacy, millions of chronic pain patients in the USA continue to use opioids as their primary source of pain management. The Centers for Disease Control recommends opioid tapering to diminish the risk of opioid dependence in chronic pain patients. However, tapering, even with physician oversight, can introduce additional harm. Thus, many pain clinicians remain ambivalent about undertaking opioid tapering. Here, we surveyed attitudes on the topic from the viewpoint of chronic pain patients who have been consuming opioids over long durations. We queried 127 chronic pain patients (pain duration = 13.5 ± 9.6 years) on long-term opioids (10.3 ± 8.2 years), primarily consuming hydrocodone or oxycodone. Sixty-six percent of participants were “very” or “extremely” interested in participating in an opioid tapering study. Patients emphasized the importance of controlling their pain during opioid tapering, and over 50% were also worried about craving symptoms. Both the desire for tapering and the worry of pain control were more pronounced in participants with a higher magnitude of ongoing back pain. The study demonstrates that most chronic pain patients using opioids are interested in decreasing opioid consumption. Yet, they worry about losing control of their chronic pain. These results imply patient-physician strategies that may aid the engagement of both parties in opioid tapering.