Prescribing and use of opioids for chronic non-malignant pain: a meta-synthesis of qualitative studies

Description

Aims

Explore doctors’ and patients’ experiences and perceptions of prescribing and taking opioids for chronic pain, to build an explanatory model of the processes underlying these phenomena.

Method

A metasynthesis of qualitative literature on selected papers through Thematic Network Analysis (TNA). Relevant papers will be identified by systematic searching through relevant databases and application of inclusion and exclusion criteria. The process of TNA will be conducted by two researchers independently before a conceptual framework is developed.

Background

Worldwide prevalence of prescription opioid use has tripled since 1991 and recent UK studies have highlighted an increase in the prescribing of strong opioids in primary care.

The resources available to the physician in addition to knowledge, experience and beliefs of the prescriber may influence prescribing practices. For instance, ease of access to physiotherapy or pain specialists, perceived or actual risk of opioid related side-effects, concerns about misuse of opioids and professional experience in the management of chronic non-malignant pain are factors that alone or combined may influence the decision making process. These issues may be compounded by a sense of scrutiny from professional regulatory authorities which may further influence their approach to prescribing.

Patient attitudes and beliefs about the condition and perspectives of clinical interventions are factors which may also have a significant impact upon the selection of specific interventions. This is especially true of opioids, since public knowledge of the negative aspects of opioids, particularly addiction and misuse of morphine, oxycodone and heroin, is widespread. Acceptance of and adherence to prescribed medicines, therefore, centres on a patient’s decision-making process in which medication concerns are consciously or unconsciously balanced with the necessity for the medication, perceived risk-benefit ratio of therapy or previous experiences with the medication.

While there have been many qualitative studies which have examined the issue of opioid use for chronic non-malignant pain from both a physician and patient viewpoint, there has been no attempt to synthesize the findings to develop an overarching set of themes to capture the phenomena.

People

Mary-Claire Kennedy

Phoebe Pallotti

Rebecca Dickinson

Clare Harley

Funding body: School of Healthcare, University of Leeds (Pump Prime) (£2,437)

Contact: Mary-Claire Kennedy