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

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

Addressing the Health Needs of an Aging America: New Opportunities for Evidence-Based Policy Solutions

This report systematically maps research findings to policy proposals intended to improve the health of the elderly. The study identified promising evidence-based policies, like those supporting prevention and care coordination, as well as areas where the research evidence is strong but policy activity is low, such as patient self-management and palliative care. Future work of the Stern Center will focus on these topics as well as long-term care financing, the health care workforce, and the role of family caregivers

Preconception Care of Women on Prescribed Opioids

The landmark 2015 report from the Center for Disease Control (CDC) posited that too many women of reproductive age received prescribed opioids. This is significant because fetal exposure to a known teratogen can have catastrophic outcomes. Furthermore, women are often ambivalent about birth control and many pregnancies are unplanned. Fortunately, women identify interactions with health care providers as acceptable cues for preconception decision making. Data has shown that Medicaid populations are disproportionately prescribed opioids compared to insured populations. However, the CDC defines reproductive status by age only. Therefore, the purpose of this research project was to identify women’s actual risk for pregnancy as defined by presence or absence of menopause, sterilization, or long-acting, reversible birth control (LARC)

Patients' attitudes to analgesics and expectations of emergency care : a thesis presented in partial fulfilment of the requirements for the degree of Master of Arts in Psychology at Massey University, Palmerston North, New Zealand

Alleviating pain and suffering has long been a goal of health professionals. Pain has been shown to be one of the leading reasons that patients present to emergency departments (ED) throughout the world and the use of analgesics in ED's has been extensively explored. What has been less extensively researched is why some patients in pain choose not to use analgesics and what it is that they expect from emergency health care. The present work is an exploratory study looking at the attitudes of patients in pain, presenting to an urban ED and declining analgesics. It asks why patients decline analgesics and what they expect from emergency care. Seven participants were recruited over a two month period and volunteered to participate in semi-structured interviews while waiting to see a health professional. Four women and three men participated. Thematic analysis led to several themes being reported. People did not like taking analgesics because their injury was "not that painful"; they used "pain as a reference point"; and they had an "aversion to taking medications". Reasons for accessing emergency services included a "need to know what's wrong" and a belief that "diagnostic tests" were required. A surprising theme to emerge was the use of dental pain as a reference point for pain tolerance and pain behaviours. It was concluded that health professionals should accept that some patients in pain do not desire analgesics. Patients have non-pharmacological means of coping with pain. They access emergency care for diagnosis, active treatment, and have an underlying need to understand the cause of their pain. It is suggested that future study might include interviews with health professionals to compare and contrast their subjective perceptions with objective observations and to investigate the use of dental pain as a reference point

The Value Driven Pharmacist: Basics of Access, Cost, and Quality 2nd Edition

https://digitalcommons.butler.edu/butlerbooks/1017/thumbnail.jp