Opioid Tapering After Orthopaedic Surgery: Protocols, Patient Fear and the Consultation That Precedes Them
DOI:
https://doi.org/10.5281/zenodo.22548476Keywords:
Opioid tapering, Postoperative pain, Persistent opioid use, Orthopaedic surgery, Prescribing guidelines, Patient communicationAbstract
A meaningful minority of opioid-naive patients who receive an opioid prescription after orthopaedic
surgery go on to use opioids persistently well beyond the expected surgical recovery window, and the
great majority of tablets prescribed after common procedures are never consumed. Prescribing
guidelines and evidence-based tapering protocols have reduced average quantities prescribed, yet
patients frequently describe the tapering conversation itself -- rather than the taper's pharmacological
logic -- as the point where the process succeeds or fails: fear that pain will return, fear of withdrawal,
and a sense of being abandoned by the prescriber recur across qualitative studies as the barriers that
actually determine whether a taper is completed. This review synthesises the prescribing-guideline
evidence, the persistent-use epidemiology, and the patient-communication literature to set out what a
defensible postoperative tapering conversation should contain.
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