Opioid-related Transitions for Chronic Pain Management: A Concept Analysis.

Abstract

Background: People who are prescribed opioids for pain management may undergo transitions of care. However, little is known about transitions of care that involve a prescribed opioid, which may have significant consequences for people with chronic pain. The purpose of this concept analysis was to define opioid-related transitions (OrTs) and characterize their attributes, antecedents, and consequences.

Methods: Rodger's evolutionary method for concept analysis was used to identify key attributes, antecedents, and consequences of OrTs. A comprehensive literature search was conducted in September 2024, resulting in the inclusion of 61 articles.

Results: As defined, OrTs occur when opioids are prescribed for chronic pain management and involve an opioid medication transition and/or transition in care settings and/or practitioners. These transitions encompass patient-clinician and clinician-clinician interactions that ideally incorporate opioid-specific information, clear communication, shared decision-making, collective responsibility, weighing the risks and benefits, and knowledge exchange during the processes of opioid prescribing, management, and monitoring. During OrTs, patients and clinicians identified a need for support with care coordination. Notably, team-based involvement in OrTs is present, but guidance for operationalizing patient and clinician support efforts is needed.

Conclusions: This concept analysis contributes to the conceptual clarity of OrTs by identifying core attributes, antecedents, and consequences. By defining and examining OrTs broadly and including chronic pain, both patient experiences and clinician approaches to managing pain during transitions of care are highlighted. Research is needed on patient and clinician experiences related to managing chronic pain with opioids and the role of nurse-led interventions during OrTs.