Experiences of people taking opioid medication for chronic non-malignant pain: a qualitative evidence synthesis using meta-ethnography

BMJ Open. 2020 Feb 18;10(2):e032988. doi: 10.1136/bmjopen-2019-032988.

Abstract

Objective: To review qualitative studies on the experience of taking opioid medication for chronic non-malignant pain (CNMP) or coming off them.

Design: This is a qualitative evidence synthesis using a seven-step approach from the methods of meta-ethnography.

Data sources and eligibility criteria: We searched selected databases-Medline, Embase, AMED, Cumulative Index to Nursing and Allied Health Literature, PsycINFO, Web of Science and Scopus (Science Citation Index and Social Science Citation Index)-for qualitative studies which provide patients' views of taking opioid medication for CNMP or of coming off them (June 2017, updated September 2018).

Data extraction and synthesis: Papers were quality appraised using the Critical Appraisal Skills Programme tool, and the GRADE-CERQual (Grading of Recommendations Assessment, Development and Evaluation working group - Confidence in Evidence from Reviews of Qualitative research) guidelines were applied. We identified concepts and iteratively abstracted these concepts into a line of argument.

Results: We screened 2994 unique citations and checked 153 full texts, and 31 met our review criteria. We identified five themes: (1) reluctant users with little choice; (2) understanding opioids: the good and the bad; (3) a therapeutic alliance: not always on the same page; (4) stigma: feeling scared and secretive but needing support; and (5) the challenge of tapering or withdrawal. A new overarching theme of 'constantly balancing' emerged from the data.

Conclusions: People taking opioids were constantly balancing tensions, not always wanting to take opioids, and weighing the pros and cons of opioids but feeling they had no choice because of the pain. They frequently felt stigmatised, were not always 'on the same page' as their healthcare professional and felt changes in opioid use were often challenging.

Trial registration number: 49470934; Pre-results.

Keywords: chronic non-malignant pain; meta-ethnography; opioid; patients’ views; qualitative evidence synthesis; qualitative research.

Publication types

  • Research Support, Non-U.S. Gov't
  • Systematic Review

MeSH terms

  • Analgesics, Opioid / therapeutic use*
  • Anthropology, Cultural
  • Attitude*
  • Chronic Pain / drug therapy*
  • Chronic Pain / psychology
  • Comprehension
  • Conflict, Psychological*
  • Drug Prescriptions*
  • Emotions*
  • Female
  • Health Knowledge, Attitudes, Practice
  • Health Personnel
  • Humans
  • Male
  • Physician-Patient Relations
  • Qualitative Research
  • Social Stigma
  • Substance Withdrawal Syndrome*

Substances

  • Analgesics, Opioid