Listen for clues that indicate which patients who are taking opioids may be open to other options

Référence

Henry SG, Gosdin MM, White AE, Kravitz RL. "It sometimes doesn't even work": patient opioid assessments as clues to therapeutic flexibility in primary care. J Gen Intern Med 35(6):1635-1640.

Sommaire

Conversations aimed at reducing opioid doses in patients with chronic pain are often fraught, usually because of fears of the inevitable conflict, gamesmanship, and manipulation. But what if patients offered clues that they might be open to dose reduction? To identify and categorize these clues, the authors analyzed recordings of 86 clinic visits of patients with chronic pain who received an average 42.5 mg morphine equivalents per day. Two authors independently listened to all the recordings. They identified 274 instances in these visits when patients offered an assessment of the opioid and 129 of these assessments as clues that express negative or ambivalent opinions toward opioids. Clues were sorted into 5 categories: (1) pain: "[It] helps a little bit with the pain"; (2) function: "If I take two, I can't function"; (3) safety: "If I have to take more I'll be in serious trouble"; (4) side effects: "I don't like it"; and (5) personal identity: "I'm in a constant war with myself when I take pain medication." More than half (53%) the visits included more than one clue from the patient and 21% contained 3 or more clues. Physicians (n = 49) explored these clues less than half (43%) the time. The authors did not report the effect of these clues; that is, whether any physicians offered other options for pain treatment or dose lowering.