Patient Patterns and Perspectives on Using Opioid Regimens for Chronic Cancer Pain

Emily M. Wright, Areej El-Jawahri, Jennifer S. Temel, Alaina Carr, Steven Safren, Elyse R. Park, William F. Pirl, Eduardo Bruera, Lara Traeger

Research output: Contribution to journalArticle

Abstract

Context: With increasing attention to the undertreatment of cancer pain in parallel with concerns about opioid misuse, little is known about how patients with advanced cancer adhere to opioid regimens for chronic cancer pain. Objectives: We explored patient approaches to managing chronic cancer pain with long-acting opioids. Methods: In a multimethods study at an academic medical center, adult patients with chronic cancer pain (n = 17) used electronic pill caps to record adherence to prescribed long-acting opioid regimens. After eight weeks, patients viewed their adherence records and completed a semistructured interview about their opioid use. With a framework approach, we coded interview data (Kappa >0.95) and identified themes in how patients perceived and used opioids to manage cancer pain. Results: Patients (59% female; 94% non-Hispanic white; median age = 65 years) felt grateful about pain benefit from opioids yet concerned about opioid side effects and addiction/tolerance. Main reasons for nonadherence included both intentional decisions (e.g., skipping doses) and unintentional barriers (e.g., missing doses due to inconsistent sleep schedules). Overall, patients set their own opioid adherence goals and developed routines to achieve them. Residual pain varied and was not consistently linked with opioid adherence. Conclusion: Patients commonly felt conflicted about using prescribed long-acting opioids to manage cancer pain due to concurrent perceptions of their risks and benefits, and they set their own parameters for opioid-taking practices. Intentional and unintentional deviations from prescribed opioid schedules highlight the need to enhance adherence communication, education, and counseling, to optimize the use of long-acting opioids as a component of cancer pain management.

Original languageEnglish (US)
JournalJournal of Pain and Symptom Management
DOIs
StatePublished - Jan 1 2019

Fingerprint

Chronic Pain
Opioid Analgesics
Cancer Pain
Appointments and Schedules
Interviews
Pain
Pain Management
Counseling
Sleep
Communication

Keywords

  • behavioral medicine
  • Cancer pain
  • medical adherence
  • palliative care
  • qualitative research

ASJC Scopus subject areas

  • Nursing(all)
  • Clinical Neurology
  • Anesthesiology and Pain Medicine

Cite this

Patient Patterns and Perspectives on Using Opioid Regimens for Chronic Cancer Pain. / Wright, Emily M.; El-Jawahri, Areej; Temel, Jennifer S.; Carr, Alaina; Safren, Steven; Park, Elyse R.; Pirl, William F.; Bruera, Eduardo; Traeger, Lara.

In: Journal of Pain and Symptom Management, 01.01.2019.

Research output: Contribution to journalArticle

Wright, Emily M. ; El-Jawahri, Areej ; Temel, Jennifer S. ; Carr, Alaina ; Safren, Steven ; Park, Elyse R. ; Pirl, William F. ; Bruera, Eduardo ; Traeger, Lara. / Patient Patterns and Perspectives on Using Opioid Regimens for Chronic Cancer Pain. In: Journal of Pain and Symptom Management. 2019.
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abstract = "Context: With increasing attention to the undertreatment of cancer pain in parallel with concerns about opioid misuse, little is known about how patients with advanced cancer adhere to opioid regimens for chronic cancer pain. Objectives: We explored patient approaches to managing chronic cancer pain with long-acting opioids. Methods: In a multimethods study at an academic medical center, adult patients with chronic cancer pain (n = 17) used electronic pill caps to record adherence to prescribed long-acting opioid regimens. After eight weeks, patients viewed their adherence records and completed a semistructured interview about their opioid use. With a framework approach, we coded interview data (Kappa >0.95) and identified themes in how patients perceived and used opioids to manage cancer pain. Results: Patients (59{\%} female; 94{\%} non-Hispanic white; median age = 65 years) felt grateful about pain benefit from opioids yet concerned about opioid side effects and addiction/tolerance. Main reasons for nonadherence included both intentional decisions (e.g., skipping doses) and unintentional barriers (e.g., missing doses due to inconsistent sleep schedules). Overall, patients set their own opioid adherence goals and developed routines to achieve them. Residual pain varied and was not consistently linked with opioid adherence. Conclusion: Patients commonly felt conflicted about using prescribed long-acting opioids to manage cancer pain due to concurrent perceptions of their risks and benefits, and they set their own parameters for opioid-taking practices. Intentional and unintentional deviations from prescribed opioid schedules highlight the need to enhance adherence communication, education, and counseling, to optimize the use of long-acting opioids as a component of cancer pain management.",
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