Nizet Pierre, Deme Laure, Evin Adrien, Kuhn Emmanuelle, Nizard Julien, Victorri Vigneau Caroline, Huon Jean-François
Nantes Université, CHU Nantes, Pharmacie, Nantes, France.
U1246 SPHERE "methodS in Patient-centered outcomes and HEalth ResEarch", Université de Nantes, Université de Tours, INSERM, Nantes, France.
Pain Pract. 2025 Jan;25(1):e13409. doi: 10.1111/papr.13409. Epub 2024 Aug 28.
Long-term use of opioids does not result in significant clinical improvement and has shown more adverse than beneficial effects in chronic pain conditions. When opioids cause more adverse effects than benefits for the patient, it may be necessary to initiate a process of deprescribing.
To explore the perceptions of French pain physicians regarding the process of opioid deprescribing in patients experiencing chronic non-cancer and to generate an understanding of the barriers and levers to the deprescribing process.
We conducted a multicentric observational study with qualitative approach. Individual semi-structured interviews exploring pain physicians' perceptions, beliefs, and representations to assess the determinants of opioid deprescribing with an interview guide were used. After checking the transcripts, an inductive and independent thematic analysis of the interviews was to extract meaningful themes from the dataset.
Twelve pain physicians were interviewed. The main obstacles to deprescribing revolved around patient-specific attributes, characteristics of the opioids themselves, and limitations within the current healthcare system, that hinder optimal patient management. Conversely, patient motivation and education, recourse to hospitalization in a Pain Department with multidisciplinary care, follow-up by the general practitioner, and training and information dissemination among patients and clinicians emerged as facilitative elements for opioid deprescribing.
This study underscores the needs to improve the training of healthcare professionals, the effective communication of pertinent information to patients, and the establishment of a therapeutic partnership with the patient. It is therefore essential to carry out the deprescribing process in a collaborative and interprofessional manner, encompassing both pharmaceutical and non-pharmaceutical strategies.
长期使用阿片类药物并不会带来显著的临床改善，并且在慢性疼痛病症中已显示出弊大于利。当阿片类药物对患者造成的不良反应多于益处时，可能有必要启动减药过程。
探讨法国疼痛科医生对慢性非癌性疼痛患者阿片类药物减药过程的看法，并了解减药过程中的障碍和推动因素。
我们采用定性方法进行了一项多中心观察性研究。通过个人半结构化访谈，使用访谈指南探索疼痛科医生的看法、信念和表现，以评估阿片类药物减药的决定因素。在检查访谈记录后，对访谈进行归纳性和独立的主题分析，以从数据集中提取有意义的主题。
对12名疼痛科医生进行了访谈。减药的主要障碍围绕患者的特定属性、阿片类药物本身的特性以及当前医疗保健系统的局限性，这些都阻碍了对患者的最佳管理。相反，患者的积极性和教育、在设有多学科护理的疼痛科住院治疗、全科医生的随访以及在患者和临床医生中进行培训和信息传播，成为阿片类药物减药的促进因素。
本研究强调需要改进医疗保健专业人员的培训、向患者有效传达相关信息以及与患者建立治疗伙伴关系。因此，以协作和跨专业的方式开展减药过程至关重要，这包括药物和非药物策略。
