title: Potential impact of abrupt opioid therapy discontinuation in the management of chronic pain: a pilot study on patient perspective.
abstract: OBJECTIVE
  This survey highlights the perspective of patients with chronic pain when confronted with the possibility of abrupt opioid discontinuation.
  
  
  METHODS
  Anonymous and self-administered survey.
  
  
  METHODS
  Pain Clinic in an urban academic hospital setting.
  
  
  METHODS
  Patients with chronic pain of at least 6 months, and age 18 years or older.
  
  
  METHODS
  The perceived impact of abrupt opioid discontinuation on mood, daily functioning, and potential for opioid misuse.
  
  
  RESULTS
  When patients were asked how they would feel if told their opioids would be discontinued, the responses were neglected (scale mean, 7.1), angry (6.3), helpless (6.7), and upset (7.0) on a scale of 0-10. The majority predicted loss of independence in activities of daily living (scale mean, 7.5), inability to enjoy their lives (7.4), and inability to work (7.8). A group of 19 patients (11.6 percent) reported that they would obtain opioids from friends or family, and 7 (4.4 percent) would obtain them illegally. These patients reported higher scores of neglect, anger, suspicion, helplessness, and upset (p = 0.000-0.019) and were more likely to have previously obtained opioids illegally (p = 0.008-0.023). The most common nonopioid strategies tried by patients were lumbar epidural (71.5 percent), physical therapy (78.9 percent), and exercise (83.5 percent). The strategies considered to be effective as opioid replacement therapy were lumbar epidural (42.3 percent), exercise (43.2 percent), and massage (42.0 percent).
  
  
  CONCLUSIONS
  These data suggest that opioid therapy discontinuation is an emotionally distressing experience for most patients, and the transition to nonopioid treatments is a complex process that will require patient participation to achieve optimal care.
authors.affiliation: Department of Pain Medicine and Palliative Care, Beth Israel Medical Center, New York, New York; Department of Medicine, Beth Israel Medical Center, New York, New York.
authors.forename: Joy
authors.initials: J
authors.lastname: Hao
authors.affiliation: The Chemical Dependency Institute, Beth Israel Medical Center, New York, New York.
authors.forename: David
authors.initials: D
authors.lastname: Lucido
authors.affiliation: Department of Pain Medicine and Palliative Care, Beth Israel Medical Center, New York, New York; Department of Neurology, Albert Einstein College of Medicine, Bronx, New York; Department of Anesthesiology, Albert Einstein College of Medicine, Bronx, New York.
authors.forename: Ricardo A
authors.initials: RA
authors.lastname: Cruciani
mesh_terms: D000203:Activities of Daily Living; D000328:Adult; D000368:Aged; D000701:Analgesics, Opioid / Q000008:administration & dosage*; D059350:Chronic Pain / Q000188:drug therapy* / Q000523:psychology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D011795:Surveys and Questionnaires
chemical_list: D000701:Analgesics, Opioid