Researchers explore patient-doctor conversations, best practices linked to opioid tapering

Increased scrutiny of opioid prescribing for patients with chronic pain has led providers and healthcare organizations to consider opioid-dose reductions, known as tapering. Such actions can precipitate communication challenges for primary-care physicians. A new study, published in The Journal of Pain, examined patient-doctor conversations and explored best practices associated with opioid tapering. The Journal of Pain is the peer-review publication of the American Pain Society, www.americanpainsociety.org.

"Institutional mandates to tamper opioid doses can lead to communication challenges with patients, especially those who have achieved pain relief from taking long-term opioids and use them as prescribed," said lead author Marianne S. Matthias, PhD, a research scientist at Indiana University School of Medicine.

Researchers analyzed audio-recorded primary-care clinic visits by patients taking opioids. They conducted in-depth interviews with patients and their doctors to identify communication challenges and best practices for opioid tapering. The study was conducted in four primary-care clinics at an academic hospital serving low-income patients.

The recorded patient-doctor conversations and interviews revealed four distinct communication patterns associated with opioid tapering: explaining reasons for tapering, negotiating the tapering plan, managing difficult conversations, and assuring patients that they will not be abandoned during the tapering process.

"In clinic visits and interviews, patients acknowledged that opioids could be harmful but, in many cases, they did not see applicability to their own situations because they had legitimate pain and took their medications as prescribed," said Matthias. She added that, in interviews, doctors noted the benefits of shifting the conversation about tapering from the abstract opioid crisis to potential risks opioids pose to an individual based on his or her own unique medical history.

Involving patients in tapering decisions was viewed favorably by doctors and patients, as patients wanted input on the tapering decisions. Doctors said they were willing to work with patients on the rate of tapering.

When communication broke down, some difficult discussions occurred, including arguments in which patients threatened to obtain opioids illegally. Doctors were not always convinced tapering was best for certain patients despite mandates, but they tended to remain silent about this topic when confronted by patients about it.

Assuring patients they would not be abandoned during opioid tapering was viewed as critical by patients and physicians. "Patients need to know that their doctors are not going to reduce their opioid doses and then disappear," said Matthias. "When doctors showed genuine concern for their patients' health and well-being, and indicated that they would be with them for the duration of the tapering process, patients with chronic pain seemed more willing to accept reduction or discontinuation of opioids."

The authors concluded that when physicians tailor their messages to help patients understand why tapering may be beneficial to them, based on their unique clinical situations and histories, they provide opportunity for input into tapering, even if it only the rate of tapering.​