Patient Perceptions on Opioid Therapy for Acute Pain Management in the Emergency Department and Post-Surgical Settings: A Qualitative Study

Evan Lucey,1– 3 Erica Dean,1,2 Brittany P Chapman,1,2,4 Richard Perugini,5 Peter Chai,6– 9 Charlotte E Goldfine,6 Stephanie Carreiro1,2 1Department of Emergency Medicine, Division of Medical Toxicology, UMass Chan Medical School, Worcester, MA, USA; 2Tox(In)novation Lab, Worcester, MA, USA; 3University of New England College of Osteopathic Medicine, Biddeford, ME, USA; 4School of Physician Assistant Studies, Massachusetts College of Pharmacy and Health Science, Worcester, MA, USA; 5Department of Surgery, UMass Chan Medical School, Worcester, MA, USA; 6Department of Emergency Medicine, Division of Medical Toxicology, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA; 7The Koch Institute for Integrated Cancer Research, Massachusetts Institute of Technology, Cambridge, MA, USA; 8Department of Psychosocial Oncology and Palliative Care, Dana Farber Cancer Institute, Boston, MA, USA; 9The Fenway Institute, Boston, MA, USACorrespondence: Stephanie Carreiro, Department of Emergency Medicine, University of Massachusetts Medical School, 55 Lake Avenue North, Worcester, MA, 01655, USA, Email [email protected]: Opioids are highly effective in treating acute pain but have various detrimental, non-therapeutic effects that may lead to the development of opioid use disorder (OUD) in certain individuals. This creates a complex landscape of opioid prescribing and use. The present manuscript uses a qualitative research lens to understand the patient experience during opioid therapy for acute pain, including perceptions, behaviors, and factors that drive both during the third wave of the opioid epidemic.Patients and Methods: Patients receiving opioids for acute pain were recruited from the emergency department and general surgery clinic as part of a larger study to perform continuous physiologic monitoring during opioid use. Semi-structured interviews were conducted within 10 days of hospital discharge. Interviews were recorded, transcribed verbatim and subject to applied thematic analysis by two independent coders.Results: Of the 60 subjects that completed the parent study, 44 completed the semi-structured interviews (mean age 47 years, 50% female). Three main themes emerged from the interviews: the direct effects of opioid analgesia, internal factors and external factors that influenced therapy. Symptoms of opioid tolerance, withdrawal and dependence were described in a subset of participants, even with a relatively short duration of therapy. Participants expressed a desire for more education around opioid therapy, and more engagement with their plan of care.Conclusion: Opioid therapy, even in short courses for acute pain, can be a complicated experience for patients to navigate. Prescribers should consider how patients’ unique experiences and perspectives shape their responses when providing counseling to patients and monitoring of response to opioid therapy.Keywords: analgesia, tolerance, stigma, post-surgical pain, goals and expectations