Reducing opioids not associated with lower patient satisfaction scores

A Kaiser Permanente study of nearly 2,500 patients who used high doses of opioids for at least six months showed that reducing their opioid use did not lower their satisfaction with care. The study, "Satisfaction With Care After Reducing Opioids for Chronic Pain," was published today in The American Journal of Managed Care.

"Physicians are often concerned they will receive lower satisfaction scores if they reduce opioids for patients who are accustomed to high opioid doses to manage chronic pain," said the study's lead author, Adam L. Sharp, MD, MS, of Kaiser Permanente Southern California Department of Research & Evaluation. "This study showed that following current recommendations and reducing opioids for chronic pain did not result in lower satisfaction scores."

Opioid use has been a major health concern in the U.S. Opioid use increased in the United States by 300 percent from 1997 to 2010, and overdose deaths increased 200 percent from 2000 to 2014. An in-depth analysis of U.S. data released by the Centers for Disease Control and Prevention in March showed that drug overdoses killed 63,632 Americans in 2016 and nearly two-thirds of those deaths involved a prescription or illicit opioid.

But reducing opioids for patients who have been prescribed the medications for many years to manage chronic pain can be challenging for physicians. One concern is reduced patient satisfaction. Researchers tracked patient encounters from 2009 to 2014 among Kaiser Permanente members in Southern California. They included 2,492 encounters with patients prescribed high doses of opioids for at least six consecutive months for chronic pain.

The study compared patient satisfaction scores between those whose dose was reduced to the recommended level for at least 30 days following the encounter on which the satisfaction score was linked and those without such a reduction. It found:

• Most encounters resulting in an opioid dose reduction maintained favorable overall satisfaction (86.4 percent).
• Reducing opioid doses for chronic pain was not associated with unfavorable patient satisfaction scores.
• The odds of a favorable satisfaction rating were higher when opioids were reduced by a patient's regular primary care physician versus a different physician.

"If you are physician, you should do the right thing and you should feel comfortable you will not receive lower patient satisfaction scores. Our results should reassure physicians and help promote use of recommended guidelines," Dr. Sharp said. "Even if you are in the small subset of physicians reducing opioids for people who are not your regular patients, there is still only small difference in overall patient satisfaction."

Dr. Sharp, who is an emergency room physician as well as a researcher, said there is a message for patients as well: "Even if you have been on opioids for years, the recommendations have changed."

He noted that physicians have learned that the high doses previously used were more likely to hurt patients than to help them with their pain.

"You should be reassured that your physician wants to follow guidelines designed to improve your health and well-being," he said. "At times, your doctor may be helping you most by prescribing less."