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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慢性疼痛患者止痛药减量：概念分析

研究目的当使用止痛药的风险和副作用大于其益处时，应考虑止痛药减量（PMT）。PMT在慢性疼痛（CP）患者的治疗方案中获得突出地位，并由异质性成分组成。本研究旨在通过概念化用于CP患者的基本成分来澄清PMT的概念。基于Walker和Avant八步法的DesignConcept分析。数据来源对截至2023年7月的六个数据库进行了全面的文献检索：MEDLINE（通过PubMed）、Web of Science、Embase、Scopus、PsychINFO和Cochrane数据库。患者长期接受疼痛药物治疗的scp患者，PMT对其有益。干预因素：属性、说明性案例、前因、后果和经验参照物被开发出来。采用系统评价和荟萃分析首选报告项目（PRISMA）指南，以提高检索的透明度和可重复性，并增加可读性和清晰度。主要结果在4162篇文章中，收录了110篇文章。确定了六个属性：药物使用和减少，支持，患者准备/教育，个性化，整个和随后的控制和监测，以及缓解疼痛的替代治疗。开发了三个案例，说明了PMT程序包含全部、部分或不包含属性。确定了诸如适合逐渐减少、患者信服、经验丰富的多学科团队和建立良好的医患关系等先决条件，并根据国际功能、残疾和健康分类描述了后果，其结果主要在身体功能和结构类别中发现。结论对CNCP患者PMT的概念化为改善PMT项目的现有知识奠定了基础，并可作为未来PMT干预研究的起点。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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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.