Faculty of Medicine and Health, Pain Management Research Institute, The University of Sydney, Sydney, Australia.
Pain. 2019 Jul;160(7):1586-1593. doi: 10.1097/j.pain.0000000000001543.
Clinicians report reluctance to deliver opioid-tapering advice to patients with chronic pain, in part due to concerns that patients will be angry and dissatisfied. An experiment was conducted to examine chronic pain patients' emotional and attitudinal responses to simulated opioid-tapering advice. Patients scheduled for an initial assessment at a tertiary pain clinic and currently taking opioid medications for pain (N = 196) were randomly assigned to view video footage of a standardized patient receiving 1 of 3 forms of treatment advice: (1) stay on current medication (2) change to a different pain medication, or (3) taper off pain medications and participate in a CBT-based pain self-management program. Participants reported how positive/enthusiastic, anxious/worried, and angry/irritable they felt in response to the simulated treatment advice, and how satisfied with and willing they would be to accept and follow the advice. Participants expressed more positive emotional and attitudinal responses to simulated opioid-tapering advice than to simulated opioid-maintenance advice. Furthermore, participants' responses to simulated opioid-tapering and opioid-change advice were not significantly different, suggesting that participants responded positively to the prospect of change in treatment strategy. Additional analyses revealed that participants with a longer history of chronic pain and opioid use responded less positively to simulated opioid-tapering advice. The results of this study contribute to our understanding of factors that may shape chronic pain patients' responses to opioid-tapering advice and suggest that patients may respond more positively to opioid-tapering advice if it is presented together with an alternative treatment approach.
临床医生报告称，他们不愿意向慢性疼痛患者提供阿片类药物减量建议，部分原因是担心患者会生气和不满。一项实验旨在研究慢性疼痛患者对模拟阿片类药物减量建议的情绪和态度反应。在一家三级疼痛诊所接受初始评估且目前正在服用阿片类药物治疗疼痛的患者（N=196）被随机分配观看标准化患者接受以下 3 种治疗建议之一的视频片段：（1）继续当前药物治疗；（2）改用不同的止痛药物；（3）减少阿片类药物并参加基于认知行为疗法的疼痛自我管理计划。参与者报告他们对模拟治疗建议的积极/热情、焦虑/担忧和愤怒/烦躁程度，以及对接受和遵循建议的满意度和意愿。与模拟阿片类药物维持建议相比，参与者对模拟阿片类药物减量建议表现出更积极的情绪和态度反应。此外，参与者对模拟阿片类药物减量和阿片类药物更换建议的反应没有显著差异，这表明参与者对治疗策略改变的前景反应积极。进一步的分析表明，慢性疼痛和阿片类药物使用史较长的参与者对模拟阿片类药物减量建议的反应不那么积极。这项研究的结果有助于我们了解可能影响慢性疼痛患者对阿片类药物减量建议反应的因素，并表明如果将阿片类药物减量建议与替代治疗方法一起提出，患者可能会对其作出更积极的反应。
