Patients With Chronic Pain and Their Perspectives on Barriers and Opportunities for Earlier Opioid Tapering-A...

Long-term opioid use is associated at the population level with increased risks such as physical dependence, adverse effects and complex healthcare trajectories. While some patients report improved function and quality of life with carefully monitored opioid therapy, others experience diminishing benefits over time and substantial harms. While tapering is clinically recommended, little is known about patients' perspectives on barriers and opportunities for initiating earlier opioid tapering. This study explores how patients experience and reflect on these issues throughout their patient journey.

We conducted semi-structured interviews with 10 patients who had completed opioid tapering at a Danish multidisciplinary pain clinic. Patient journey mapping was used to visualise and structure individual treatment journeys. Data were analysed using reflexive thematic analysis and supported by NVivo software.

Two overarching themes emerged: (1) living between fear of pain and dependence on opioids included emotional ambivalence, fear of pain recurrence, and insufficient guidance from healthcare providers; (2) Tapering responsibility falling through the cracks, illustrated how tapering responsibility often became fragmented across the healthcare system, leaving participants feeling unsupported and uncertain about how to initiate change. Conversely, proactive engagement by healthcare professionals, particularly general practitioners, enabled participants to consider tapering.

This study identified personal and systemic barriers to opioid tapering, including fear of pain, emotional dependence, and fragmented care. Participants favoured earlier tapering, but success depended on addressing these factors and enhancing general practitioners' knowledge. Meaningful tapering becomes possible when healthcare professional responsiveness meets individual readiness.