Opioid tapering after surgery: a qualitative study of patients' experiences

Background and aims Patients usually receive a prescription for morphine or another opioid at discharge after surgery. Several studies have shown that many patients do not step down but develop persistent opioid use following surgery. The purpose of this study was to gain insight of patients' experiences with opioid tapering after surgery and to propose recommendations for clinicians to assist patients in opioid tapering. Methods Using a qualitative study design, 15 adult patients who took opioids before surgery and still had a daily consumption of opioids 6 months following spine surgery were interviewed. Results Analyses of the transcripts identified three major themes and eight subthemes. The major themes were as follows: (1) The patients' experienced that their whole life revolved around pain and opioids and felt stigmatized and suspected of being drug addicts by their social circle and health care professionals (2) Barriers for opioid tapering were increased pain, opioid dependency and fear of withdrawal symptoms (3) Motivational factors for opioid tapering were fear of dependency, the prospect of a better health, patient involvement in opioid tapering and a trusting relationship between patient and clinician. Conclusions The results of this study highlight that opioid tapering is challenging and may be influenced by many different factors. Some patients find opioid tapering particularly difficult and therefore need additional assistance in order to taper off successfully. Implications For opioid tapering to succeed, it is highly important to establish a trustful relationship with the patients, to take each patient's personal circumstances into account and to address fears of increased pain and withdrawal symptoms. Clinicians should also focus on patient involvement in opioid tapering and consider to offer a follow-up after discharge to patients at risk for prolonged opioid use.