"I'm Not Gonna Pull the Rug out From Under You": Patient-Provider Communication About Opioid Tapering

J Pain. 2017 Nov;18(11):1365-1373. doi: 10.1016/j.jpain.2017.06.008. Epub 2017 Jul 8.


In response to increases in harms associated with prescription opioids, opioid prescribing has come under greater scrutiny, leading many health care organizations and providers to consider or mandate opioid dose reductions (tapering) for patients with chronic pain. Communicating about tapering can be difficult, particularly for patients receiving long-term opioids who perceive benefits and are using their medications as prescribed. Because of the importance of effective patient-provider communication for pain management and recent health system-level initiatives and provider practices to taper opioids, this study used qualitative methods to understand communication processes related to opioid tapering, to identify best practices and opportunities for improvement. Up to 3 clinic visits per patient were audio-recorded, and individual interviews were conducted with patients and their providers. Four major themes emerged: 1) explaining-patients needed to understand individualized reasons for tapering, beyond general, population-level concerns such as addiction potential, 2) negotiating-patients needed to have input, even if it was simply the rate of tapering, 3) managing difficult conversations-when patients and providers did not reach a shared understanding, difficulties and misunderstandings arose, and 4) nonabandonment-patients needed to know that their providers would not abandon them throughout the tapering process.

Perspective: Although opioid tapering can be challenging, helping patients to understand individualized reasons for tapering, encouraging patients to have input into the process, and assuring patients they would not be abandoned all appear to facilitate optimal communication about tapering.

Keywords: Chronic pain; opioid tapering; opioids; patient-centered care; patient-provider communication.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Adult
  • Aged
  • Analgesics, Opioid / administration & dosage*
  • Chronic Pain / drug therapy*
  • Chronic Pain / psychology*
  • Fear
  • Female
  • Health Communication / methods*
  • Health Personnel / psychology
  • Humans
  • Interviews as Topic
  • Male
  • Middle Aged
  • Opioid-Related Disorders / prevention & control
  • Patient Participation
  • Patient-Centered Care / methods*
  • Precision Medicine / methods
  • Primary Health Care / methods*
  • Professional-Patient Relations
  • Qualitative Research
  • Young Adult


  • Analgesics, Opioid