Medical Record Documentation About Opioid Tapering: Examining Benefit-to-Harm Framework and Patient Engagement

Michele Buonora, Hector R. Perez, Jordan Stumph, Robert Allen, Shadi Nahvi, Chinazo O. Cunningham, Jessica S. Merlin, Joanna L. Starrels

Research output: Contribution to journalArticlepeer-review


OBJECTIVE: Guidelines recommend that clinicians make decisions about opioid tapering for patients with chronic pain using a benefit-to-harm framework and engaging patients. Studies have not examined clinician documentation about opioid tapering using this framework. DESIGN AND SETTING: Thematic and content analysis of clinician documentation about opioid tapering in patients' medical records in a large academic health system. METHODS: Medical records were reviewed for patients aged 18 or older, without cancer, who were prescribed stable doses of long-term opioid therapy between 10/2015 and 10/2016 then experienced an opioid taper (dose reduction ≥30%) between 10/2016 and 10/2017. Inductive thematic analysis of clinician documentation within six months of taper initiation was conducted to understand rationale for taper, and deductive content analysis was conducted to determine the frequencies of a priori elements of a benefit-to-harm framework. RESULTS: Thematic analysis of 39 patients' records revealed 1) documented rationale for tapering prominently cited potential harms of continuing opioids, rather than observed harms or lack of benefits; 2) patient engagement was variable and disagreement with tapering was prominent. Content analysis found no patients' records with explicit mention of benefit-to-harm assessments. Benefits of continuing opioids were mentioned in 56% of patients' records, observed harms were mentioned in 28%, and potential harms were mentioned in 90%. CONCLUSIONS: In this study, documentation of opioid tapering focused on potential harms of continuing opioids, indicated variable patient engagement, and lacked a complete benefit-to-harm framework. Future initiatives should develop standardized ways of incorporating a benefit-to-harm framework and patient engagement into clinician decisions and documentation about opioid tapering.

Original languageEnglish (US)
Pages (from-to)2574-2582
Number of pages9
JournalPain medicine (Malden, Mass.)
Issue number10
StatePublished - Oct 1 2020


  • Chronic Pain
  • Clinician Documentation
  • Opioid Taper
  • Pain Management
  • Primary Care

ASJC Scopus subject areas

  • Clinical Neurology
  • Anesthesiology and Pain Medicine

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