Exploring Pain Clinical Specialists’ Perspectives on Opioid Optimization for Chronic Non-Malignant Pain in England

The use of opioids for chronic non-malignant pain (CNMP) offers limited efficacy and carries the potential for addiction. Healthcare professionals in both primary and secondary care settings face challenges when attempting to optimise opioid medications. There are limited studies that investigated the barriers and enablers to opioid reduction, cessation, and optimisation, specifically from a pain clinical specialist perspective. This study explores pain clinical specialists' views on challenges in opioid prescription management-including optimization and tapering-and their interactions with patients and prescribers. Participants were recruited through pain clinic, webinars Email outreach, and professional networks. Semi-structured interviews were conducted using a guide based on the Theoretical Domains Framework (TDF) with 11 pain clinical specialists (8 consultants and 3 pharmacists) from NHS England, out of 15 participants who initially expressed interest, recruited via professional networks. Thematic analysis employed Framework Approach with dual coding. Eleven participants, comprising eight pain doctors and three clinical pharmacists, provided insights. Analysis revealed four key findings: (1) A paradigm shift away from long-term opioid therapy due to concerns about dependency and inadequate pain relief; (2) Strong preference for multidisciplinary, personalized treatment approaches; (3) Significant system-level barriers including care fragmentation and inadequate consultation time; (4) Critical need for enhanced clinician training and patient education programs. Optimizing opioid use for CNMP requires fundamental changes to current practice, including implementation of integrated care pathways, extended consultation times, and comprehensive education initiatives. These findings provide evidence-based recommendations for improving pain management while reducing inappropriate opioid prescribing.