Pain medication tapering in chronic pain patients: a concept analysis

IF 5 2区医学 Q1 ANESTHESIOLOGY

Journal of Clinical Anesthesia Pub Date : 2025-02-22 DOI:10.1016/j.jclinane.2025.111784

Elke Wuyts , Frenn Bultinck , Lisa Goudman , Dries Ceulemans , Cleo Lina Crunelle , Dominique Van de Velde , Hubert Van Puyenbroeck , Maarten Moens

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引用次数: 0

Abstract

Study objective

When risks and side effects of pain medication use outweigh its benefits, pain medication tapering (PMT) should be considered. PMT gained prominence in the treatment plan for patients with chronic pain (CP) and consist of heterogeneous components. This study aims to clarify the concept of PMT by conceptualizing essential components for use in CP patients.

Design

Concept analysis based on the eight-step method of Walker and Avant.

Data sources

A comprehensive literature search up to July 2023 was performed in six databases: MEDLINE (via PubMed), Web of Science, Embase, Scopus, PsychINFO and the Cochrane database.

Patients

CP patients on long-term pain medication therapy to whom PMT is beneficial.

Interventions

Attributes, illustrative cases, antecedents, consequences and empirical referents were developed. The Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines were used for transparency and reproducibility of the search, and to increase readability and clarity.

Main results

Out of 4,162 articles, 110 articles were included. Six attributes were identified: medication use and decrease, support, patient preparation/education, personalization, controlling and monitoring throughout and following tapering, and alternative treatments for pain relief. Three cases were developed, illustrating PMT programs containing all, some or none of the attributes. Antecedents such as suitability for tapering, convinced patient, experienced multidisciplinary team and well-established patient-physician relationship were identified, and consequences were described according to the International Classification of Functioning, Disability and Health, with results predominantly found in the body functions and structures category.

Conclusion

Conceptualization of PMT for patients with CNCP creates a common ground for improving current knowledge about PMT programs and can serve as a starting point for development of future research into PMT interventions.

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来源期刊

Journal of Clinical Anesthesia 医学-麻醉学

CiteScore

7.40

自引率

4.50%

发文量

346

审稿时长

23 days

期刊介绍： The Journal of Clinical Anesthesia (JCA) addresses all aspects of anesthesia practice, including anesthetic administration, pharmacokinetics, preoperative and postoperative considerations, coexisting disease and other complicating factors, cost issues, and similar concerns anesthesiologists contend with daily. Exceptionally high standards of presentation and accuracy are maintained. The core of the journal is original contributions on subjects relevant to clinical practice, and rigorously peer-reviewed. Highly respected international experts have joined together to form the Editorial Board, sharing their years of experience and clinical expertise. Specialized section editors cover the various subspecialties within the field. To keep your practical clinical skills current, the journal bridges the gap between the laboratory and the clinical practice of anesthesiology and critical care to clarify how new insights can improve daily practice.