Patient and Provider Acceptability of a Patient Preauthorized Concealed Opioid Reduction

Theresa Bedford, Timileyin Adediran, Nathaniel R Haycock, C Daniel Mullins, Michelle Medeiros, Thelma Wright, Michele Curatolo, Lynette Hamlin, Luana Colloca, Theresa Bedford, Timileyin Adediran, Nathaniel R Haycock, C Daniel Mullins, Michelle Medeiros, Thelma Wright, Michele Curatolo, Lynette Hamlin, Luana Colloca

Abstract

Objective: Limited research of how to best taper opioids brings about an ethical and clinical dilemma. Experiments using overt and concealed administration of opioids have demonstrated the benefits of a concealed reduction to eliminate negative expectations and prolong analgesic benefits. This may allow for opioid tapering without significant increases in pain. Based on this, we investigated patient and provider acceptance of a concealed opioid reduction for chronic pain.

Methods: We conducted a cross-sectional survey via REDcap with 74 patients, who are currently taking or have taken high dose opioids, and 49 providers using a validated questionnaire based on two hypothetical clinical trials comparing a patient preauthorized concealed opioid reduction vs standard tapering.

Results: We found that patients and providers have positive attitudes toward a concealed reduction of opioid dosages. More than 60% of providers and patients surveyed viewed the hypothetical clinical trial as helpful to reduce pain, side effects, and withdrawal symptoms. Sixty-one percent of patients and 77.6% of providers recognized that there would be differences in pain relief depending upon which group the hypothetical participants would be enrolled in.

Conclusions: Patients and providers appear to understand the benefits of a concealed opioid reduction. Our findings support future randomized controlled trials that compare concealed and overt opioid tapering in patients with chronic pain. More research is needed to understand the difference in attitudes between research and clinical practice and to test the acceptability of a concealed reduction following a participation in an active clinical trial.

Keywords: Chronic Pain. Expectations; Concealed (hidden) administration; Opioid-tapering; Placebo Effects.

Conflict of interest statement

The opinions expressed herein are those of the authors and are not necessarily representative of the official policy or position of the Uniformed Services University of the Health Sciences, Department of Defense, Department of Health Affairs, or United States Air Force. The funding agencies have no roles in the study. The views expressed here are the authors’ own and do not reflect the position or policy of the Agency for Healthcare Research and Quality, Maryland State and University of Maryland or any other part of the federal and state government.

© The Author(s) 2021. Published by Oxford University Press on behalf of the American Academy of Pain Medicine. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Figures

Figure 1.
Figure 1.
Patient and provider response comparison. More than 60% of patients and 90% of providers surveyed responded positively to the question. Providers were statistically more likely to respond to this statement positively than patients, X2 = (1, n = 134) = 15.730, P < .001. n = number; X2 = chi-square; P = probability.
Figure 2.
Figure 2.
Patient and provider response comparison on participating in/referring to the hypothetical study. More than 80% of providers were comfortable referring patients for the hypothetical study, compared to 60% of patients were comfortable participating in the hypothetical study, X2 = (1, n = 134) = 6.589, P = .010. n = number; X2 = chi-square; P = probability.

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Source: PubMed

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