General practitioners’ views about opioid management and tapering before hip or knee replacement surgery: a qualitative study

Background Total hip or knee replacement (arthroplasty) is common in aging populations as are prescribed opioids for osteoarthritis pain while awaiting such surgeries. Opioid-related harm can be minimised through pre-surgery tapering of opioids yet, the practice is uncommon.

Aim This research sought to understand general practitioners (GPs) understandings, beliefs and support needs for managing pain while waiting surgery, use of opioids and pre-surgery tapering.

Design & setting A qualitative study with GPs in Australia.

Method Semi-structured interviews were conducted. Data were transcribed, deidentified and reflectively analysed inductively and thematically.

Results Analysis of transcript data from GP interviews (n=17) revealed little knowledge of, yet support for, pre-arthroplasty opioid tapering as a further way to minimise opioid harm. Three themes described were: 1. feeling challenged by pre-surgery pain management and opioid prescribing; 2. optimal pain management and tapering prevented by patient-related and system-level barriers; and 3. sharing workload and perceived risk – pharmacists could provide opioid management support.

Conclusion Realisation of potential opioid tapering benefits will require addressing some personal, patient and system level barriers revealed by this study. GPs view support from pharmacists as valuable and welcomed yet the required collaborative models appear, currently, underdeveloped between these primary care professions. Implementation research is a crucial next area of inquiry.