- •Patients experience tapering as a dynamic, nonlinear process.
- •Tapering requires substantial effort across many domains of patients’ daily lives.
- •Patients typically discuss only some of their tapering strategies with clinicians.
- The prescribed opioids difficulties scale: A patient-centered assessment of problems and concerns.Clin J Pain. 2010; 26: 489-497
- Tapering long-term opioid therapy in chronic noncancer pain: Evidence and recommendations for everyday practice.Mayo Clin Proc. 2015; 90: 828-842
- Trends in use of opioids by noncancer pain type 2000-2005 among Arkansas Medicaid and HealthCore enrollees: results from the TROUP study.J Pain. 2008; 9: 1026-1035
- Prevalence and most common causes of disability among adults—United States, 2005.MWMR. 2009; 58: 421-426
- Development and validation of the Current Opioid Misuse Measure.Pain. 2007; 130: 144-156
- The Nature of Suffering and the Goals of Medicine.2nd ed. Oxford University Press, New York, NY2004
- Good Days, Bad Days: The Self in Chronic Illness and Time.Rutgers University Press, Rutgers, NJ1991
- Patient-centered prescription opioid tapering in community outpatients with chronic pain.JAMA Intern Med. 2018; 178: 707-708
Department of Veterans Affairs/Department of Defense: VA/DoD clinical practice guideline for opioid therapy for chronic pain. 2017 Available from https://www.healthquality.va.gov/guidelines/Pain/cot/VADoDOTCPG022717.pdf. Accessed 16 October 2018.
- CDC guideline for prescribing opioids for chronic pain—United States, 2016.JAMA. 2016; 315: 1624-1645
- Doctors and patients in pain: Conflict and collaboration in opioid prescription in primary care.Pain. 2014; 155: 2575-2582
- Patients' perspectives on tapering of chronic opioid therapy: A qualitative study.Pain Med. 2016; 17: 1838-1847
- Patient outcomes in dose reduction or discontinuation of long-term opioid therapy: A systematic review.Ann Intern Med. 2017; 167: 181-191
- Declines in opioid prescribing after a private insurer policy change - Massachusetts, 2011-2015.MMWR Morb Mortal Wkly Rep. 2016; 65: 1125-1131
- Persistent pain and well-being: A World Health Organization study in primary care.JAMA. 1998; 280: 147-151
- Vital signs: Changes in opioid prescribing in the United States, 2006-2015.MMWR Morb Mortal Wkly Rep. 2017; 66: 697-704
- The Health Belief Model. In Introduction to Health Behavior Theory.2nd ed. Jones & Bartlett, Burlington, MA,2014: 63-106
- Goals of chronic pain management: Do patients and primary care physicians agree and does it matter?.Clin J Pain. 2017; 33: 955-961
- The Active Interview.Sage, Thousand Oaks, CA1995
- "Those conversations in my experience don't go well": A qualitative study of primary care provider experiences tapering long-term opioid medications.Pain Med. 2017 Nov 4; ([Epub ahead of print])
- Development and initial validation of the PEG, a three-item scale assessing pain intensity and interference.J Gen Intern Med. 2009; 24: 733-738
- "I'm not gonna pull the rug out from under you": Patient-provider communication about opioid tapering.J Pain. 2017; 18: 1365-1373
- Communicating about opioids for chronic pain: A qualitative study of patient attributions and the influence of the patient-physician relationship.Eur J Pain. 2014; 18: 835-843
- The patient-provider relationship in chronic pain care: Providers' perspectives.Pain Med. 2010; 11: 1688-1697
- Qualitative Data Analysis: An Expanded Sourcebook.2nd ed. Sage, Thousand Oaks, CA1994
- The Discourse of Medicine: Dialectics of Medical Interviews.Ablex, Norwood, NJ1984
- Increases in drug and opioid overdose deaths—United States, 2000–2014.MMWR. 2016; 64: 1378-1382
- Increases in drug and opioid-involved overdose deaths—United States, 2010-2015.MMWR Morb Mortal Wkly Rep. 2016; 65: 1445-1452
- Dread and the disvalue of future pain.PLoS Comput Biol. 2013; 9e1003335
- "They don't want anything to do with you": Patient views of primary care management of chronic pain.Pain Med. 2010; 11: 1791-1798
This work was supported by the National Institutes of Health grants R21DA042269 and K23DA043052.
Presented at the Society of General Internal Medicine Annual Meeting, April 13, 2018, in Denver, Colorado.
The authors have no conflicts of interest to declare.