{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,31]],"date-time":"2026-03-31T03:37:41Z","timestamp":1774928261769,"version":"3.50.1"},"reference-count":135,"publisher":"National Institute for Health and Care Research","license":[{"start":{"date-parts":[[2026,3,1]],"date-time":"2026-03-01T00:00:00Z","timestamp":1772323200000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100000664","name":"Health Technology Assessment programme","doi-asserted-by":"publisher","award":["NIHR128842"],"award-info":[{"award-number":["NIHR128842"]}],"id":[{"id":"10.13039\/501100000664","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["journalslibrary.nihr.ac.uk"],"crossmark-restriction":false},"short-container-title":["Health Technol Assess"],"abstract":"<jats:sec id=\"abs1-1\">\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Opioids are prescribed for the management of chronic non-cancer pain, but they have important limitations and evidence does not support long-term use. People taking opioids therefore need support to reduce or stop use.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"abs1-2\">\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>The research aimed to inform better practice, pathways and service design to support people to reduce or stop their use of opioids and address inequalities.<\/jats:p>\n                    <jats:p>Our objectives were to evaluate evidence on:<\/jats:p>\n                    <jats:list list-type=\"bullet\">\n                      <jats:list-item>\n                        <jats:p>effectiveness, safety (including adverse effects, adverse event) and acceptability of interventions to reduce opioid use<\/jats:p>\n                      <\/jats:list-item>\n                      <jats:list-item>\n                        <jats:p>barriers and facilitators to effective intervention<\/jats:p>\n                      <\/jats:list-item>\n                      <jats:list-item>\n                        <jats:p>inequalities in access to, acceptability of and benefiting from interventions.<\/jats:p>\n                      <\/jats:list-item>\n                    <\/jats:list>\n                  <\/jats:sec>\n                  <jats:sec id=\"abs1-3\">\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We undertook four systematic reviews of published evidence on effectiveness; safety and acceptability; barriers and facilitators and inequalities. Searches included databases [MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, PsycInfo\u00ae (American Psychological Association, Washington, DC, USA)], trial registries (EU-CTR, International Standard Randomised Controlled Trial Number, Australian New Zealand Clinical Trials Register, ClinicalTrials.gov), websites (National Institute for Health and Care Research \u2013 be part of research, National Institute for Health and Care Excellence Evidence Search, Health Management Information Consortium, British Pain Society Members area) and repositories (Google Scholar, CORE.ac.uk) up to September 2022.<\/jats:p>\n                    <jats:p>Records were independently assessed for inclusion using prespecified criteria: (1) adults with chronic non-cancer pain, with (2) prescription opioid use of at least 3 months experiencing an (3) intervention aiming reduce or discontinue the use of opioids. Cochrane Risk-of-Bias tool for randomised controlled trials and the appropriate Critical Appraisal Skills Programme tool were used for cohort, case-control and qualitative studies.<\/jats:p>\n                    <jats:p>For the reviews of effectiveness and safety, data were synthesised and presented using tables and narrative synthesis. Meta-analysis was not appropriate. The barriers and facilitators review used thematic synthesis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"abs1-4\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>A total of 44 studies (reported across 52 papers) were included in at least 1 of the reviews: 27 studies were included in the effectiveness, 7 in safety and 16 in the barriers and facilitators reviews. All but two studies provided evidence for the inequalities review.<\/jats:p>\n                    <jats:sec id=\"abs1-4-1\">\n                      <jats:title>Effectiveness and safety<\/jats:title>\n                      <jats:p>The characteristics of the included studies were heterogeneous with different intervention approaches examined.<\/jats:p>\n                      <jats:p>Fifteen studies reported effects on pain. There was no difference in pain severity between intervention and control groups across seven of eight comparative studies. All but two studies reported change in opioid use. The proportion of patients who ceased opioid use varied across studies and some studies reported evidence of later relapse. Other outcomes, including anxiety and depression and sleep quality, were examined across the included studies but there was no clear pattern of effect. No adverse event studies reported serious adverse event and no participants reportedly withdrew due to adverse event. Few studies examined intervention acceptability.<\/jats:p>\n                    <\/jats:sec>\n                    <jats:sec id=\"abs1-4-2\">\n                      <jats:title>Barriers and facilitators<\/jats:title>\n                      <jats:p>Eight barriers and eight facilitators were identified. They highlight the complex nature of the tapering process with the potential for multiple interdependent, behavioural, structural and contextual barriers to arise.<\/jats:p>\n                    <\/jats:sec>\n                    <jats:sec id=\"abs1-4-3\">\n                      <jats:title>Inequalities<\/jats:title>\n                      <jats:p>Most studies reported on PROGnosis RESearch Strategy partnership-Plus categories, but few considered impact. Our findings suggest males and older patients experience poorer tapering outcomes.<\/jats:p>\n                    <\/jats:sec>\n                  <\/jats:sec>\n                  <jats:sec id=\"abs1-5\">\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Evidence to support any specific opioid tapered reduction intervention is mixed and uncertain. Our findings reinforce that service design and delivery require careful consideration of individual-level factors and highlight the potential to widen inequalities.<\/jats:p>\n                    <jats:p>Stakeholders consulted on the evidence suggest valuing relationships, addressing fear and stigma and upskilling in behaviour change techniques are key.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"abs1-6\">\n                    <jats:title>Study registration<\/jats:title>\n                    <jats:p>This study is registered as PROSPERO CRD42020171135.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"abs1-7\">\n                    <jats:title>Funding<\/jats:title>\n                    <jats:p>\n                      This award was funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme (NIHR award ref: NIHR128842) and is published in full in\n                      <jats:italic>Health Technology Assessment<\/jats:italic>\n                      ; Vol. 30, No. 27. See the NIHR Funding and Awards website for further award information.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.3310\/gdwp3572","type":"journal-article","created":{"date-parts":[[2024,10,14]],"date-time":"2024-10-14T08:05:16Z","timestamp":1728893116000},"page":"1-249","update-policy":"https:\/\/doi.org\/10.3310\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Interventions to safely and effectively reduce (taper) use of opioids in chronic non-cancer pain: a systematic review"],"prefix":"10.3310","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2801-0505","authenticated-orcid":true,"given":"Ruaraidh","family":"Hill","sequence":"first","affiliation":[{"name":"Liverpool Reviews and Implementation Group, Health Data Science, Institute of Population Health, University of Liverpool, Liverpool, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4419-6343","authenticated-orcid":true,"given":"Michelle","family":"Maden","sequence":"additional","affiliation":[{"name":"Liverpool Reviews and Implementation Group, Health Data Science, Institute of Population Health, University of Liverpool, Liverpool, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6485-7415","authenticated-orcid":true,"given":"Rui","family":"Duarte","sequence":"additional","affiliation":[{"name":"Liverpool Reviews and Implementation Group, Health Data Science, Institute of Population Health, University of Liverpool, Liverpool, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9250-1886","authenticated-orcid":true,"given":"Sam","family":"Eldabe","sequence":"additional","affiliation":[{"name":"Department of Anaesthesia and Pain Management, South Tees Hospitals NHS Foundation Trust, Middlesbrough, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8987-5211","authenticated-orcid":true,"given":"Su","family":"Golder","sequence":"additional","affiliation":[{"name":"Department of Health Science, The University of York, York, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7097-8704","authenticated-orcid":true,"given":"Marty","family":"Chaplin","sequence":"additional","affiliation":[{"name":"Liverpool Reviews and Implementation Group, Health Data Science, Institute of Population Health, University of Liverpool, Liverpool, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4693-9956","authenticated-orcid":true,"given":"Beth","family":"Shaw","sequence":"additional","affiliation":[{"name":"Center for Evidence-based Policy, Oregon Health and Science University, Portland, OR, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5469-8649","authenticated-orcid":true,"given":"Katy","family":"Sutcliffe","sequence":"additional","affiliation":[{"name":"Evidence for Policy and Practice Information and Coordination Centre, Social Research Institute, University College London, London, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1496-9341","authenticated-orcid":true,"given":"Adam","family":"Todd","sequence":"additional","affiliation":[{"name":"School of Pharmacy, University of Newcastle upon Tyne, Newcastle upon Tyne, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5578-1535","authenticated-orcid":true,"given":"Rebecca","family":"Bresnahan","sequence":"additional","affiliation":[{"name":"Liverpool Reviews and Implementation Group, Health Data Science, Institute of Population Health, University of Liverpool, Liverpool, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1092-0092","authenticated-orcid":true,"given":"Katherine","family":"Edwards","sequence":"additional","affiliation":[{"name":"Liverpool Reviews and Implementation Group, Health Data Science, Institute of Population Health, University of Liverpool, Liverpool, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4812-1904","authenticated-orcid":true,"given":"Janette","family":"Greenhalgh","sequence":"additional","affiliation":[{"name":"Liverpool Reviews and Implementation Group, Health Data Science, Institute of Population Health, University of Liverpool, Liverpool, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2026-3778","authenticated-orcid":true,"given":"Juliet","family":"Hounsome","sequence":"additional","affiliation":[{"name":"Liverpool Reviews and Implementation Group, Health Data Science, Institute of Population Health, University of Liverpool, Liverpool, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-3904-2165","authenticated-orcid":true,"given":"Jack","family":"Trafford","sequence":"additional","affiliation":[{"name":"Liverpool Reviews and Implementation Group, Health Data Science, Institute of Population Health, University of Liverpool, Liverpool, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8078-409X","authenticated-orcid":true,"given":"Nefyn","family":"Williams","sequence":"additional","affiliation":[{"name":"Primary Care and Mental Health, Institute of Population Health, University of Liverpool, Liverpool, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"6221","published-online":{"date-parts":[[2026,3]]},"reference":[{"key":"key2026033107571800_ref1-bib1","doi-asserted-by":"crossref","first-page":"1976","DOI":"10.1097\/j.pain.0000000000001939","article-title":"The revised International Association for the Study of Pain definition of pain: concepts, challenges, and compromises","volume":"161","author":"Raja","year":"2020","journal-title":"Pain"},{"key":"key2026033107571800_ref2-bib2","doi-asserted-by":"crossref","first-page":"19","DOI":"10.1097\/j.pain.0000000000001384","article-title":"Chronic pain as a symptom or a disease: the IASP Classification of Chronic Pain for the International Classification of Diseases (ICD-11)","volume":"160","author":"Treede","year":"2019","journal-title":"Pain"},{"key":"key2026033107571800_ref3-bib3","doi-asserted-by":"crossref","first-page":"1211","DOI":"10.1016\/S0140-6736(17)32154-2","article-title":"Global, regional, and national incidence, prevalence, and years lived with disability for 328 diseases and injuries for 195 countries, 1990\u20132016: a systematic analysis for the Global Burden of Disease Study 2016","volume":"390","author":"Vos","year":"2017","journal-title":"Lancet"},{"key":"key2026033107571800_ref4-bib4","doi-asserted-by":"crossref","first-page":"e010364","DOI":"10.1136\/bmjopen-2015-010364","article-title":"Prevalence of chronic pain in the UK: a systematic review and meta-analysis of population studies","volume":"6","author":"Fayaz","year":"2016","journal-title":"BMJ Open"},{"key":"key2026033107571800_ref5-bib5","doi-asserted-by":"crossref","first-page":"4832","DOI":"10.1093\/rheumatology\/keab109","article-title":"Estimating the population health burden of musculoskeletal conditions using primary care electronic health records","volume":"60","author":"Yu","year":"2021","journal-title":"Rheumatology (Oxford)"},{"key":"key2026033107571800_ref7-bib7","doi-asserted-by":"crossref","first-page":"384","DOI":"10.1038\/bjp.2008.100","article-title":"Cellular neuroadaptations to chronic opioids: tolerance, withdrawal and addiction","volume":"154","author":"Christie","year":"2008","journal-title":"Br J Pharmacol"},{"key":"key2026033107571800_ref8-bib8","doi-asserted-by":"crossref","first-page":"129","DOI":"10.1007\/s11916-010-0171-1","article-title":"Opioid-induced hyperalgesia: clinically relevant or extraneous research phenomenon?","volume":"15","author":"Tompkins","year":"2011","journal-title":"Curr Pain Headache Rep"},{"key":"key2026033107571800_ref9-bib9","doi-asserted-by":"crossref","DOI":"10.1002\/14651858.CD012509","article-title":"High\u2010dose opioids for chronic non\u2010cancer pain: an overview of Cochrane Reviews","volume":"10","author":"Els","year":"2017","journal-title":"Cochrane Database Syst Rev"},{"key":"key2026033107571800_ref10-bib10","doi-asserted-by":"crossref","first-page":"276","DOI":"10.7326\/M14-2559","article-title":"The effectiveness and risks of long-term opioid therapy for chronic pain: a systematic review for a National Institutes of Health Pathways to Prevention Workshop","volume":"162","author":"ChouDana","year":"2015","journal-title":"Ann Intern Med"},{"key":"key2026033107571800_ref11-bib11","volume-title":"IASP Statement on Opioids for Pain Management","author":"International Association for Study of Pain","year":"2018"},{"key":"key2026033107571800_ref12-bib12","doi-asserted-by":"crossref","first-page":"697","DOI":"10.15585\/mmwr.mm6626a4","article-title":"Vital signs: changes in opioid prescribing in the United States, 2006\u20132015","volume":"66","author":"GuyMurphy","year":"2017","journal-title":"MMWR Morb Mortal Wkly Rep"},{"key":"key2026033107571800_ref13-bib13","doi-asserted-by":"crossref","first-page":"140","DOI":"10.1016\/S2215-0366(18)30471-1","article-title":"Opioid prescribing trends and geographical variation in England, 1998\u20132018: a retrospective database study","volume":"6","author":"Curtis","year":"2019","journal-title":"Lancet Psychiatry"},{"key":"key2026033107571800_ref15-bib15","doi-asserted-by":"crossref","first-page":"e1003270","DOI":"10.1371\/journal.pmed.1003270","article-title":"Birlie Time trends and prescribing patterns of opioid drugs in UK primary care patients with non-cancer pain: a retrospective cohort study","volume":"17","author":"Jani","year":"2020","journal-title":"PLOS Med"},{"key":"key2026033107571800_ref16-bib16","first-page":"1487","article-title":"Vital signs: overdoses of prescription opioid pain relievers \u2013 United States, 1999\u20132008","volume":"60","author":"Centers for Disease Control and Prevention","year":"2011","journal-title":"MMWR Morb Mortal Wkly Rep"},{"key":"key2026033107571800_ref17-bib17","doi-asserted-by":"crossref","first-page":"272","DOI":"10.5694\/mja17.01152","article-title":"Primary care management of non-specific low back pain: key messages from recent clinical guidelines","volume":"208","author":"Almeida","year":"2018","journal-title":"Med J Aust"},{"key":"key2026033107571800_ref19-bib19","volume-title":"The National Patient Safety Improvement Programmes","author":"NHS England","year":"2021"},{"key":"key2026033107571800_ref20-bib20","volume-title":"Opioid Aware","author":"Faculty of Pain Medicine","year":"2022"},{"key":"key2026033107571800_ref21-bib21","article-title":"Interventions for the reduction of prescribed opioid use in chronic non-cancer pain","volume":"11","author":"EcclestonKnaggs","year":"2017","journal-title":"Cochrane Database Syst Rev"},{"key":"key2026033107571800_ref22-bib22","doi-asserted-by":"crossref","first-page":"181","DOI":"10.7326\/M17-0598","article-title":"Patient outcomes in dose reduction or discontinuation of long-term opioid therapy: a systematic review","volume":"167","author":"Frank","year":"2017","journal-title":"Ann Intern Med"},{"key":"key2026033107571800_ref23-bib23","doi-asserted-by":"crossref","first-page":"2179","DOI":"10.1093\/pm\/pny231","article-title":"Does opioid tapering in chronic pain patients result in improved pain or same pain vs increased pain at taper completion? A structured evidence-based systematic review","volume":"20","author":"Fishbain","year":"2019","journal-title":"Pain Med"},{"key":"key2026033107571800_ref25-bib25","doi-asserted-by":"crossref","first-page":"1246","DOI":"10.1139\/cjfr-2018-0205","article-title":"on \u201cBarriers to enhanced and integrated climate change adaptation and mitigation in Canadian forest management\u201d","volume":"48","author":"Williamson","year":"2018","journal-title":"Can J Forest Res"},{"key":"key2026033107571800_ref26-bib26","doi-asserted-by":"crossref","first-page":"387","DOI":"10.1136\/bmjqs-2021-014186","article-title":"Barriers and enablers to monitoring and deprescribing opioid analgesics for chronic non-cancer pain: a systematic review with qualitative evidence synthesis using the Theoretical Domains Framework","volume":"31","author":"Cross","year":"2022","journal-title":"BMJ Qual Saf"},{"key":"key2026033107571800_ref27-bib27","doi-asserted-by":"crossref","first-page":"e225","DOI":"10.3399\/bjgp18X695057","article-title":"Patterns of regional variation of opioid prescribing in primary care in England: a retrospective observational study","volume":"68","author":"Mordecai","year":"2018","journal-title":"Br J Gen Pract"},{"key":"key2026033107571800_ref29-bib29","doi-asserted-by":"crossref","first-page":"45","DOI":"10.1186\/1471-2288-8-45","article-title":"Methods for the thematic synthesis of qualitative research in systematic reviews","volume":"8","author":"Thomas","year":"2008","journal-title":"BMC Med Res Methodol"},{"key":"key2026033107571800_ref30-bib30","doi-asserted-by":"crossref","first-page":"120","DOI":"10.1097\/XEB.0000000000000282","article-title":"Methodological guidance for the conduct of mixed methods systematic reviews","volume":"19","author":"Stern","year":"2021","journal-title":"JBI Evid Implement"},{"key":"key2026033107571800_ref31-bib31","doi-asserted-by":"crossref","first-page":"n71","DOI":"10.1136\/bmj.n71","article-title":"The PRISMA 2020 statement: an updated guideline for reporting systematic reviews","volume":"372","author":"Page","year":"2021","journal-title":"BMJ"},{"key":"key2026033107571800_ref32-bib32","doi-asserted-by":"crossref","first-page":"118","DOI":"10.1186\/1471-2288-13-118","article-title":"Towards a methodology for cluster searching to provide conceptual and contextual \u2018richness\u2019 for systematic reviews of complex interventions: case study (CLUSTER)","volume":"13","author":"Booth","year":"2013","journal-title":"BMC Med Res Methodol"},{"key":"key2026033107571800_ref33-bib33","doi-asserted-by":"crossref","first-page":"210","DOI":"10.1186\/s13643-016-0384-4","article-title":"Rayyan-a web and mobile app for systematic reviews","volume":"5","author":"Ouzzani","year":"2016","journal-title":"Syst Rev"},{"key":"key2026033107571800_ref34-bib34","doi-asserted-by":"crossref","first-page":"355","DOI":"10.1108\/07378830610692127","article-title":"Clear and present questions: formulating questions for evidence based practice","volume":"24","author":"Booth","year":"2006","journal-title":"Libr Hi Tech"},{"key":"key2026033107571800_ref35-bib35","doi-asserted-by":"crossref","first-page":"56","DOI":"10.1016\/j.jclinepi.2013.08.005","article-title":"Applying an equity lens to interventions: using PROGRESS ensures consideration of socially stratifying factors to illuminate inequities in health","volume":"67","author":"O\u2019Neill","year":"2014","journal-title":"J Clin Epidemiol"},{"key":"key2026033107571800_ref36-bib36","doi-asserted-by":"crossref","first-page":"l4898","DOI":"10.1136\/bmj.l4898","article-title":"RoB 2: a revised tool for assessing risk of bias in randomised trials","volume":"366","author":"Sterne","year":"2019","journal-title":"BMJ"},{"key":"key2026033107571800_ref37-bib37","doi-asserted-by":"crossref","first-page":"d5928","DOI":"10.1136\/bmj.d5928","article-title":"The Cochrane Collaboration\u2019s tool for assessing risk of bias in randomised trials","volume":"343","author":"Higgins","year":"2011","journal-title":"BMJ"},{"key":"key2026033107571800_ref38-bib38","volume-title":"CASP Cohort Study Checklist","author":"Critical Appraisal Skills Programme","year":"2022"},{"key":"key2026033107571800_ref39-bib39","volume-title":"CASP Qualitative Checklist","author":"Critical Appraisal Skills Programme","year":"2020"},{"key":"key2026033107571800_ref40-bib40","volume-title":"CASP Randomised Controlled Trial Checklist","author":"Critical Appraisal Skills Programme","year":"2020"},{"key":"key2026033107571800_ref41-bib41","first-page":"31","article-title":"Optimising the value of the critical appraisal skills programme (CASP) tool for quality appraisal in qualitative evidence synthesis","volume":"1","author":"Long","year":"2020","journal-title":"Res Methods Med Health Sci"},{"key":"key2026033107571800_ref42-bib42","article-title":"Interventions to support the resilience and mental health of frontline health and social care professionals during and after a disease outbreak, epidemic or pandemic: a mixed methods systematic review","volume":"11","author":"Pollock","year":"2020","journal-title":"Cochrane Database Syst Rev"},{"key":"key2026033107571800_ref43-bib43","doi-asserted-by":"crossref","first-page":"13","DOI":"10.1186\/s13012-017-0691-8","article-title":"Applying GRADE-CERQual to qualitative evidence synthesis findings-paper 4: how to assess coherence","volume":"13","author":"Colvin","year":"2018","journal-title":"Implement Sci"},{"key":"key2026033107571800_ref44-bib44","doi-asserted-by":"crossref","first-page":"14","DOI":"10.1186\/s13012-017-0692-7","article-title":"Applying GRADE-CERQual to qualitative evidence synthesis findings-paper 5: how to assess adequacy of data","volume":"13","author":"Glenton","year":"2018","journal-title":"Implement Sci"},{"key":"key2026033107571800_ref45-bib45","doi-asserted-by":"crossref","first-page":"10","DOI":"10.1186\/s13012-017-0689-2","article-title":"Applying GRADE-CERQual to qualitative evidence synthesis findings-paper 2: how to make an overall CERQual assessment of confidence and create a summary of qualitative findings table","volume":"13","author":"Lewin","year":"2018","journal-title":"Implement Sci"},{"key":"key2026033107571800_ref46-bib46","doi-asserted-by":"crossref","first-page":"9","DOI":"10.1186\/s13012-017-0690-9","article-title":"Applying GRADE-CERQual to qualitative evidence synthesis findings-paper 3: how to assess methodological limitations","volume":"13","author":"Munthe-Kaas","year":"2018","journal-title":"Implement Sci"},{"key":"key2026033107571800_ref47-bib47","doi-asserted-by":"crossref","first-page":"4","DOI":"10.1186\/s13012-017-0693-6","article-title":"Applying GRADE-CERQual to qualitative evidence synthesis findings-paper 6: how to assess relevance of the data","volume":"13","author":"Noyes","year":"2018","journal-title":"Implement Sci"},{"key":"key2026033107571800_ref48-bib48","doi-asserted-by":"crossref","first-page":"2547","DOI":"10.1016\/j.sapharm.2021.04.004","article-title":"Deprescribing: moving beyond barriers and facilitators","volume":"18","author":"Thompson","year":"2022","journal-title":"Res Social Adm Pharm"},{"key":"key2026033107571800_ref49-bib49","doi-asserted-by":"crossref","first-page":"220","DOI":"10.1111\/hir.12108","article-title":"Systematic searching for theory to inform systematic reviews: is it feasible? Is it desirable?","volume":"32","author":"Booth","year":"2015","journal-title":"Health Info Libr J"},{"key":"key2026033107571800_ref50-bib50","doi-asserted-by":"crossref","first-page":"78","DOI":"10.1016\/j.jclinepi.2015.12.009","article-title":"Current use was established and Cochrane guidance on selection of social theories for systematic reviews of complex interventions was developed","volume":"75","author":"Noyes","year":"2016","journal-title":"J Clin Epidemiol"},{"key":"key2026033107571800_ref51-bib51","doi-asserted-by":"crossref","first-page":"1308","DOI":"10.1111\/dme.13686","article-title":"Barriers to and enablers of diabetic retinopathy screening attendance: a systematic review of published and grey literature","volume":"35","author":"Graham-Rowe","year":"2018","journal-title":"Diabet Med"},{"key":"key2026033107571800_ref52-bib52","doi-asserted-by":"crossref","first-page":"37","DOI":"10.1186\/1748-5908-7-37","article-title":"Validation of the theoretical domains framework for use in behaviour change and implementation research","volume":"7","author":"Cane","year":"2012","journal-title":"Implement Sci"},{"key":"key2026033107571800_ref53-bib53","doi-asserted-by":"crossref","first-page":"26","DOI":"10.1136\/qshc.2004.011155","article-title":"Making psychological theory useful for implementing evidence based practice: a consensus approach","volume":"14","author":"Michie","year":"2005","journal-title":"Qual Saf Health Care"},{"key":"key2026033107571800_ref54-bib54","doi-asserted-by":"crossref","first-page":"660","DOI":"10.1111\/j.1464-0597.2008.00341.x","article-title":"From theory to intervention: mapping theoretically derived behavioural determinants to behaviour change techniques","volume":"57","author":"Michie","year":"2008","journal-title":"Appl Psychol"},{"key":"key2026033107571800_ref55-bib55","doi-asserted-by":"crossref","first-page":"18","DOI":"10.1186\/1475-9276-12-18","article-title":"Patient-centred access to health care: conceptualising access at the interface of health systems and populations","volume":"12","author":"Levesque","year":"2013","journal-title":"Int J Equity Health"},{"key":"key2026033107571800_ref56-bib56","doi-asserted-by":"crossref","first-page":"e342","DOI":"10.3399\/BJGP.2021.0375","article-title":"Accessing primary care and the importance of \u2018human fit\u2019: a qualitative participatory case study","volume":"72","author":"Voorhees","year":"2022","journal-title":"Br J Gen Pract"},{"key":"key2026033107571800_ref57-bib57","doi-asserted-by":"crossref","first-page":"4019","DOI":"10.1111\/bcp.15379","article-title":"A review of trial and real-world data applying elements of a realist approach to identify behavioural mechanisms supporting practitioners to taper opioids","volume":"88","author":"Bhattacharya","year":"2022","journal-title":"Br J Clin Pharmacol"},{"key":"key2026033107571800_ref58-bib58","doi-asserted-by":"crossref","first-page":"59","DOI":"10.1186\/s12875-019-0947-2","article-title":"Understanding the behavioural determinants of opioid prescribing among family physicians: a qualitative study","volume":"20","author":"Desveaux","year":"2019","journal-title":"BMC Fam Pract"},{"key":"key2026033107571800_ref59-bib59","doi-asserted-by":"crossref","first-page":"77","DOI":"10.1186\/s13012-017-0605-9","article-title":"A guide to using the theoretical domains framework of behaviour change to investigate implementation problems","volume":"12","author":"Atkins","year":"2017","journal-title":"Implement Sci"},{"key":"key2026033107571800_ref60-bib60","volume-title":"Annals of Child Development","author":"Bronfenbrenner","year":"1989"},{"key":"key2026033107571800_ref61-bib61","volume-title":"Developing NICE Guidelines: The Manual","author":"National Institute for Health and Care Excellence"},{"key":"key2026033107571800_ref62-bib62","doi-asserted-by":"crossref","first-page":"4083","DOI":"10.1016\/j.sapharm.2022.07.043","article-title":"Opioid deprescribing: qualitative perspectives from those with chronic non-cancer pain","volume":"18","author":"HamiltonBlyth","year":"2022","journal-title":"Res Social Adm Pharm"},{"key":"key2026033107571800_ref63-bib63","doi-asserted-by":"crossref","first-page":"e518","DOI":"10.1097\/j.pain.0000000000002340","article-title":"Barriers, facilitators, and resources to opioid deprescribing in primary care: experiences of general practitioners in Australia","volume":"163","author":"Hamilton","year":"2022","journal-title":"Pain"},{"key":"key2026033107571800_ref64-bib64","doi-asserted-by":"crossref","first-page":"241","DOI":"10.1016\/j.japh.2022.05.019","article-title":"\u2018I really had somebody in my corner\u2019. Patient experiences with a pharmacist-led opioid tapering program","volume":"63","author":"Schneider","year":"2022","journal-title":"J Am Pharm Assoc"},{"key":"key2026033107571800_ref65-bib65","doi-asserted-by":"crossref","first-page":"1722","DOI":"10.1007\/s11606-021-07210-9","article-title":"Patient perspectives on improving patient-provider relationships and provider communication during opioid tapering","volume":"37","author":"Kosakowski","year":"2022","journal-title":"J Gen Intern Med"},{"key":"key2026033107571800_ref66-bib66","doi-asserted-by":"crossref","first-page":"434","DOI":"10.22454\/FamMed.2019.502509","article-title":"Teaching opioid tapering through guided instruction","volume":"51","author":"Austin","year":"2019","journal-title":"Fam Med"},{"key":"key2026033107571800_ref67-bib67","doi-asserted-by":"crossref","first-page":"2438","DOI":"10.1093\/pm\/pny320","article-title":"Intensity of withdrawal symptoms during opioid taper in patients with chronic pain-individualized or fixed starting dosage?","volume":"20","author":"Bienek","year":"2019","journal-title":"Pain Med"},{"key":"key2026033107571800_ref68-bib68","doi-asserted-by":"crossref","first-page":"1676","DOI":"10.1093\/pm\/pnv079","article-title":"Opioid tapering in fibromyalgia patients: experience from an interdisciplinary pain rehabilitation program","volume":"17","author":"Cunningham","year":"2016","journal-title":"Pain Med"},{"key":"key2026033107571800_ref69-bib69","doi-asserted-by":"crossref","first-page":"448","DOI":"10.1037\/a0035798","article-title":"Mindfulness-oriented recovery enhancement for chronic pain and prescription opioid misuse: results from an early-stage randomized controlled trial","volume":"82","author":"Garland","year":"2014","journal-title":"J Consult Clin Psychol"},{"key":"key2026033107571800_ref70-bib70","doi-asserted-by":"crossref","first-page":"740","DOI":"10.1097\/AJP.0000000000000967","article-title":"Clinical effectiveness of an outpatient multidisciplinary chronic pain management telementoring service","volume":"37","author":"Gersch","year":"2021","journal-title":"Clin J Pain"},{"key":"key2026033107571800_ref71-bib71","doi-asserted-by":"crossref","first-page":"836","DOI":"10.1038\/s41386-020-00831-4","article-title":"Endogenous theta stimulation during meditation predicts reduced opioid dosing following treatment with mindfulness-oriented recovery enhancement","volume":"46","author":"Hudak","year":"2020","journal-title":"Neuropsychopharmacology"},{"key":"key2026033107571800_ref72-bib72","doi-asserted-by":"crossref","first-page":"1380","DOI":"10.1097\/j.pain.0000000000000907","article-title":"Sustained improvements in pain, mood, function and opioid use post interdisciplinary pain rehabilitation in patients weaned from high and low dose chronic opioid therapy","volume":"158","author":"Huffman","year":"2017","journal-title":"Pain"},{"key":"key2026033107571800_ref73-bib73","doi-asserted-by":"crossref","first-page":"15","DOI":"10.1080\/08897077.2015.1129527","article-title":"Implementing an opioid risk assessment telephone clinic: outcomes from a pharmacist-led initiative in a large Veterans Health Administration primary care clinic, December 15, 2014\u2013March 31, 2015","volume":"37","author":"Jacobs","year":"2016","journal-title":"Subst Abus"},{"key":"key2026033107571800_ref74-bib74","doi-asserted-by":"crossref","first-page":"760","DOI":"10.1097\/AJP.0b013e31827c7cf6","article-title":"Low pain intensity after opioid withdrawal as a first step of a comprehensive pain rehabilitation program predicts long-term nonuse of opioids in chronic noncancer pain","volume":"29","author":"Krumova","year":"2013","journal-title":"Clin J Pain"},{"key":"key2026033107571800_ref75-bib75","doi-asserted-by":"crossref","first-page":"1528","DOI":"10.1002\/ejp.1241","article-title":"Tapering off long-term opioid therapy in chronic non-cancer pain patients: a randomized clinical trial","volume":"22","author":"Kurita","year":"2018","journal-title":"Eur J Pain"},{"key":"key2026033107571800_ref76-bib76","doi-asserted-by":"crossref","first-page":"3385","DOI":"10.2147\/JPR.S273025","article-title":"Cognitive function during opioid tapering in patients with chronic pain: a prospective cohort study","volume":"13","author":"Laigaard","year":"2020","journal-title":"J Pain Res"},{"key":"key2026033107571800_ref77-bib77","doi-asserted-by":"crossref","first-page":"38","DOI":"10.1089\/acu.2019.1382","article-title":"Battlefield acupuncture for chronic pain management in patients on long-term opioid therapy","volume":"32","author":"Montgomery","year":"2020","journal-title":"Med Acupunct"},{"key":"key2026033107571800_ref78-bib78","doi-asserted-by":"crossref","first-page":"109","DOI":"10.1097\/AJP.0b013e3182579935","article-title":"Opioid cessation and multidimensional outcomes after interdisciplinary chronic pain treatment","volume":"29","author":"Murphy","year":"2013","journal-title":"Clin J Pain"},{"key":"key2026033107571800_ref79-bib79","doi-asserted-by":"crossref","first-page":"122","DOI":"10.1016\/j.pmn.2021.09.003","article-title":"Evaluation of chronic, noncancer pain management initiative in a multidisciplinary pain clinic","volume":"23","author":"Panicker","year":"2022","journal-title":"Pain Manag Nurs"},{"key":"key2026033107571800_ref80-bib80","doi-asserted-by":"crossref","first-page":"40","DOI":"10.1016\/j.addbeh.2018.04.018","article-title":"Impact of multidisciplinary chart reviews on opioid dose reduction and monitoring practices","volume":"86","author":"Rivich","year":"2018","journal-title":"Addict Behav"},{"key":"key2026033107571800_ref81-bib81","doi-asserted-by":"crossref","first-page":"1238","DOI":"10.1007\/s11606-019-05572-9","article-title":"Opioid reduction and risk mitigation in VA primary care: outcomes from the integrated pain team initiative","volume":"35","author":"Seal","year":"2020","journal-title":"J Gen Intern Med"},{"key":"key2026033107571800_ref82-bib82","first-page":"e196","article-title":"Satisfaction with care after reducing opioids for chronic pain","volume":"24","author":"Sharp","year":"2018","journal-title":"Am J Manag Care"},{"key":"key2026033107571800_ref83-bib83","doi-asserted-by":"crossref","first-page":"2450","DOI":"10.1093\/pm\/pnx293","article-title":"Impact of opioid dose reduction and risk mitigation initiatives on chronic opioid therapy patients at higher risk for opioid-related adverse outcomes","volume":"19","author":"Thakral","year":"2018","journal-title":"Pain Med"},{"key":"key2026033107571800_ref84-bib84","doi-asserted-by":"crossref","first-page":"101","DOI":"10.1016\/j.jpain.2015.10.002","article-title":"The impact of opioid risk reduction initiatives on high-dose opioid prescribing for patients on chronic opioid therapy","volume":"17","author":"Von Korff","year":"2016","journal-title":"J Pain"},{"key":"key2026033107571800_ref85-bib85","doi-asserted-by":"crossref","first-page":"90","DOI":"10.1016\/j.drugpo.2017.05.053","article-title":"Prevalence of prescription opioid use disorder among chronic opioid therapy patients after health plan opioid dose and risk reduction initiatives","volume":"46","author":"Von Korff","year":"2017","journal-title":"Int J Drug Policy"},{"key":"key2026033107571800_ref86-bib86","doi-asserted-by":"crossref","first-page":"578","DOI":"10.3122\/jabfm.2018.04.180021","article-title":"Doctor-patient trust among chronic pain patients on chronic opioid therapy after opioid risk reduction initiatives: a survey","volume":"31","author":"Sherman","year":"2018","journal-title":"J Am Board Fam Med"},{"key":"key2026033107571800_ref87-bib87","doi-asserted-by":"crossref","first-page":"111","DOI":"10.1016\/j.jpain.2017.09.006","article-title":"Comparing pain and depressive symptoms of chronic opioid therapy patients receiving dose reduction and risk mitigation initiatives with usual care","volume":"19","author":"Thakral","year":"2018","journal-title":"J Pain"},{"key":"key2026033107571800_ref88-bib88","doi-asserted-by":"crossref","first-page":"177","DOI":"10.1016\/j.pain.2008.08.005","article-title":"A longitudinal study of the efficacy of a comprehensive pain rehabilitation program with opioid withdrawal: comparison of treatment outcomes based on opioid use status at admission","volume":"140","author":"Townsend","year":"2008","journal-title":"Pain"},{"key":"key2026033107571800_ref89-bib89","doi-asserted-by":"crossref","first-page":"2769","DOI":"10.2147\/JPR.S175402","article-title":"Impact of opioid dose reduction on individuals with chronic pain: results of an online survey","volume":"11","author":"Twillman","year":"2018","journal-title":"J Pain Res"},{"key":"key2026033107571800_ref90-bib90","doi-asserted-by":"crossref","first-page":"167","DOI":"10.1016\/j.sjpain.2017.09.005","article-title":"Opioid tapering in patients with prescription opioid use disorder: a retrospective study","volume":"17","author":"Zhou","year":"2017","journal-title":"Scand J Pain"},{"key":"key2026033107571800_ref91-bib91","first-page":"907015","article-title":"Medical cannibus as an alternative for opioids for chronic pain: a case report","volume":"8","author":"Caldera","year":"2020","journal-title":"SAGE Open Med Case Rep"},{"key":"key2026033107571800_ref92-bib92","doi-asserted-by":"crossref","first-page":"395","DOI":"10.1186\/s12888-016-1112-2","article-title":"Experience of the use of Ketamine to manage opioid withdrawal in an addicted woman: a case report","volume":"16","author":"Lalanne","year":"2016","journal-title":"BMC Psychiatry"},{"key":"key2026033107571800_ref93-bib93","doi-asserted-by":"crossref","first-page":"108664","DOI":"10.1016\/j.drugalcdep.2021.108664","article-title":"\u2018I felt like I had a scarlet letter\u2019: recurring experiences of structural stigma surrounding opioid tapers among patients with chronic, non-cancer pain","volume":"222","author":"Benintendi","year":"2021","journal-title":"Drug Alcohol Depend"},{"key":"key2026033107571800_ref94-bib94","doi-asserted-by":"crossref","first-page":"1213","DOI":"10.1093\/pm\/pnaa442","article-title":"\u2018We need to taper\u2019 interviews with clinicians and pharmacists about use of a pharmacy-led opioid tapering program","volume":"22","author":"Firemark","year":"2021","journal-title":"Pain Med"},{"key":"key2026033107571800_ref95-bib95","doi-asserted-by":"crossref","first-page":"248","DOI":"10.1016\/j.japh.2020.12.019","article-title":"Factors associated with opioid-tapering success: a mixed methods study","volume":"61","author":"Kuntz","year":"2021","journal-title":"J Am Pharm Assoc"},{"key":"key2026033107571800_ref96-bib96","doi-asserted-by":"crossref","first-page":"1838","DOI":"10.1093\/pm\/pnw078","article-title":"Patients\u2019 perspectives on tapering of chronic opioid therapy: a qualitative study","volume":"17","author":"Frank","year":"2016","journal-title":"Pain Med"},{"key":"key2026033107571800_ref97-bib97","doi-asserted-by":"crossref","first-page":"1357","DOI":"10.1093\/pm\/pnx220","article-title":"Barriers to using nonpharmacologic approaches and reducing opioid use in primary care","volume":"19","author":"Giannitrapani","year":"2018","journal-title":"Pain Med"},{"key":"key2026033107571800_ref98-bib98","doi-asserted-by":"crossref","first-page":"23","DOI":"10.1016\/j.hjdsi.2017.06.006","article-title":"Challenges to teaming for pain in primary care","volume":"6","author":"Giannitrapani","year":"2018","journal-title":"Healthc (Amst)"},{"key":"key2026033107571800_ref99-bib99","doi-asserted-by":"crossref","first-page":"181","DOI":"10.1016\/j.jpain.2018.09.001","article-title":"Patients\u2019 experience with opioid tapering: a conceptual model with recommendations for clinicians","volume":"20","author":"Henry","year":"2019","journal-title":"J Pain"},{"key":"key2026033107571800_ref100-bib100","doi-asserted-by":"crossref","first-page":"1635","DOI":"10.1007\/s11606-019-05421-9","article-title":"\u2018It sometimes doesn\u2019t even work\u2019: patient opioid assessments as clues to therapeutic flexibility in primary care","volume":"35","author":"Henry","year":"2019","journal-title":"J Gen Intern Med"},{"key":"key2026033107571800_ref101-bib101","doi-asserted-by":"crossref","first-page":"955","DOI":"10.1097\/AJP.0000000000000488","article-title":"Goals of chronic pain management: do patients and primary care physicians agree and does it matter?","volume":"33","author":"Henry","year":"2017","journal-title":"Clin J Pain"},{"key":"key2026033107571800_ref102-bib102","doi-asserted-by":"crossref","first-page":"2201","DOI":"10.1093\/pm\/pnx276","article-title":"\u2018Those conversations in my experience don\u2019t go well\u2019: a qualitative study of primary care provider experiences tapering long-term opioid medications","volume":"19","author":"Kennedy","year":"2018","journal-title":"Pain Med"},{"key":"key2026033107571800_ref103-bib103","first-page":"10881","article-title":"Challenges of opioid deprescribing and factors to be considered in the development of opioid deprescribing guidelines: a qualitative analysis","volume":"30","author":"Langford","year":"2020","journal-title":"BMJ Qual Saf"},{"key":"key2026033107571800_ref104-bib104","doi-asserted-by":"crossref","first-page":"e25969","DOI":"10.2196\/25969","article-title":"McmHealth interventions to support prescription opioid tapering in patients with chronic pain: qualitative study of patients\u2019 perspectives","volume":"5","author":"Magee","year":"2021","journal-title":"JMIR Form Res"},{"key":"key2026033107571800_ref105-bib105","doi-asserted-by":"crossref","first-page":"1365","DOI":"10.1016\/j.jpain.2017.06.008","article-title":"\u2018I\u2019m not gonna pull the rug out from under you\u2019: patient-provider communication about opioid tapering","volume":"18","author":"Matthias","year":"2017","journal-title":"J Pain"},{"key":"key2026033107571800_ref106-bib106","doi-asserted-by":"crossref","first-page":"e246","DOI":"10.1097\/j.pain.0000000000002336","article-title":"A qualitative trajectory analysis of patients\u2019 experiences tapering opioids for chronic pain","volume":"163","author":"McNeilage","year":"2022","journal-title":"Pain"},{"key":"key2026033107571800_ref107-bib107","doi-asserted-by":"crossref","first-page":"120","DOI":"10.1177\/2049463720974053","article-title":"Hopes and fears before opioid tapering: a quantitative and qualitative study of patients with chronic pain and long-term opioids","volume":"15","author":"Quinlan","year":"2021","journal-title":"Br J Pain"},{"key":"key2026033107571800_ref108-bib108","doi-asserted-by":"crossref","first-page":"6","DOI":"10.5334\/ijic.5426","article-title":"Integrated primary healthcare opioid tapering interventions: a mixed-methods study of feasibility and acceptability in two general practices in New South Wales, Australia","volume":"20","author":"White","year":"2020","journal-title":"Int J Integr Care"},{"key":"key2026033107571800_ref109-bib109","first-page":"793","article-title":"Adapting the social-ecological framework for chronic pain management and successful opioid tapering","volume":"119","author":"Wu","year":"2019","journal-title":"J Am Osteopath Assoc"},{"key":"key2026033107571800_ref110-bib110","doi-asserted-by":"crossref","first-page":"56","DOI":"10.1080\/00325481.2019.1685298","article-title":"Evaluation of the effects of CBD hemp extract on opioid use and quality of life indicators in chronic pain patients: a prospective cohort study","volume":"132","author":"Capano","year":"2020","journal-title":"Postgrad Med"},{"key":"key2026033107571800_ref111-bib111","doi-asserted-by":"crossref","first-page":"153","DOI":"10.1089\/acu.2020.1450","article-title":"Auricular acupuncture to facilitate outpatient opioid weaning: a randomized pilot study","volume":"33","author":"Jackson","year":"2021","journal-title":"Med Acupunct"},{"key":"key2026033107571800_ref112-bib112","doi-asserted-by":"crossref","first-page":"671","DOI":"10.1016\/j.ejpain.2007.10.003","article-title":"The effect of electroacupuncture on opioid-like medication consumption by chronic pain patients: a pilot randomized controlled clinical trial","volume":"12","author":"Zheng","year":"2008","journal-title":"Eur J Pain"},{"key":"key2026033107571800_ref113-bib113","doi-asserted-by":"crossref","first-page":"308","DOI":"10.1016\/j.jpain.2016.11.003","article-title":"Prescription opioid taper support for outpatients with chronic pain: a randomized controlled trial","volume":"18","author":"Sullivan","year":"2017","journal-title":"J Pain"},{"key":"key2026033107571800_ref114-bib114","volume-title":"Pilot Trial of Opioid Taper Support (POTS)","author":"ClinicalTrials.gov","year":"2013"},{"key":"key2026033107571800_ref115-bib115","doi-asserted-by":"crossref","first-page":"169","DOI":"10.1186\/1745-6215-13-169","article-title":"Effect of electroacupuncture on opioid consumption in patients with chronic musculoskeletal pain: protocol of a randomised controlled trial","volume":"13","author":"Xue","year":"2012","journal-title":"Trials"},{"key":"key2026033107571800_ref116-bib116","doi-asserted-by":"crossref","first-page":"397","DOI":"10.1093\/pm\/pny113","article-title":"Effects of electroacupuncture on opioid consumption in patients with chronic musculoskeletal pain: a multicenter randomized controlled trial","volume":"20","author":"Zheng","year":"2019","journal-title":"Pain Med (Malden, Mass)"},{"key":"key2026033107571800_ref117-bib117","doi-asserted-by":"crossref","first-page":"1019","DOI":"10.1111\/pme.12699","article-title":"Opioid dose reduction in a VA health care system: implementation of a primary care population-level initiative","volume":"16","author":"Westanmo","year":"2015","journal-title":"Pain Med (Malden, Mass)"},{"key":"key2026033107571800_ref118-bib118","volume-title":"The Behaviour Change Wheel: A Guide to Designing Interventions","author":"Michie","year":"2014"},{"key":"key2026033107571800_ref119-bib119","volume-title":"CASP Case Control Checklist","author":"Critical Appraisal Skills Programme","year":"2022"},{"key":"key2026033107571800_ref120-bib120","doi-asserted-by":"crossref","first-page":"2446","DOI":"10.1097\/j.pain.0000000000001952","article-title":"McInterpretation of chronic pain clinical trial outcomes: IMMPACT recommended considerations","volume":"161","author":"Smith","year":"2020","journal-title":"Pain"},{"key":"key2026033107571800_ref121-bib121","doi-asserted-by":"crossref","first-page":"87","DOI":"10.1016\/j.jclinepi.2018.05.007","article-title":"Minimum clinically important differences in chronic pain vary considerably by baseline pain and methodological factors: systematic review of empirical studies","volume":"101","author":"Olsen","year":"2018","journal-title":"J Clin Epidemiol"},{"key":"key2026033107571800_ref122-bib122","doi-asserted-by":"crossref","first-page":"2574","DOI":"10.1093\/pm\/pnz361","article-title":"Medical record documentation about opioid tapering: examining benefit-to-harm framework and patient engagement","volume":"21","author":"Buonora","year":"2020","journal-title":"Pain Med"},{"key":"key2026033107571800_ref123-bib123","doi-asserted-by":"crossref","first-page":"639","DOI":"10.1007\/s11606-011-1806-6","article-title":"A re-conceptualization of access for 21st century healthcare","volume":"26","author":"Fortney","year":"2011","journal-title":"J Gen Intern Med"},{"key":"key2026033107571800_ref124-bib124","doi-asserted-by":"crossref","first-page":"742","DOI":"10.1037\/amp0000068","article-title":"Structural stigma: research evidence and implications for psychological science","volume":"71","author":"Hatzenbuehler","year":"2016","journal-title":"Am Psychol"},{"key":"key2026033107571800_ref125-bib125","doi-asserted-by":"crossref","first-page":"1322","DOI":"10.2105\/AJPH.89.9.1322","article-title":"Evaluating the public health impact of health promotion interventions: the RE-AIM framework","volume":"89","author":"Glasgow","year":"1999","journal-title":"Am J Public Health"},{"key":"key2026033107571800_ref126-bib126","doi-asserted-by":"crossref","first-page":"42","DOI":"10.1186\/1748-5908-6-42","article-title":"The behaviour change wheel: a new method for characterising and designing behaviour change interventions","volume":"6","author":"Michie","year":"2011","journal-title":"Implement Sci"},{"key":"key2026033107571800_ref127-bib127","doi-asserted-by":"crossref","first-page":"277","DOI":"10.1016\/S0140-6736(21)01653-6","article-title":"A time of crisis for the opioid epidemic in the USA","volume":"398","author":"The Lancet","year":"2021","journal-title":"Lancet"},{"key":"key2026033107571800_ref128-bib128","doi-asserted-by":"crossref","first-page":"1624","DOI":"10.1001\/jama.2016.1464","article-title":"CDC guideline for prescribing opioids for chronic pain: United States, 2016","volume":"315","author":"Dowell","year":"2016","journal-title":"JAMA"},{"key":"key2026033107571800_ref129-bib129","volume-title":"Medicines Associated with Dependence or Withdrawal Symptoms: Safe Prescribing and Withdrawal Management for Adults. NG215","author":"National Institute for Health and Care Excellence","year":"2022"},{"key":"key2026033107571800_ref130-bib130","first-page":"584","article-title":"Tapering opioids using motivational interviewing","volume":"64","author":"Crawley","year":"2018","journal-title":"Can Fam Physician"},{"key":"key2026033107571800_ref131-bib131","doi-asserted-by":"crossref","first-page":"113","DOI":"10.1007\/s11606-021-07085-w","article-title":"Engagement in prescription opioid tapering research: the EMPOWER study and a coproduction model of success","volume":"37","author":"Mardian","year":"2022","journal-title":"J Gen Intern Med"},{"key":"key2026033107571800_ref132-bib132","doi-asserted-by":"crossref","first-page":"bjgpopen20X101096","DOI":"10.3399\/bjgpopen20X101096","article-title":"Barriers and facilitators to deprescribing in primary care: a systematic review","volume":"4","author":"Doherty","year":"2020","journal-title":"BJGP Open"},{"key":"key2026033107571800_ref133-bib133","doi-asserted-by":"crossref","first-page":"74","DOI":"10.1186\/s13012-021-01142-y","article-title":"Barriers and facilitators to shared decision-making in hospitals from policy to practice: a systematic review","volume":"16","author":"Waddell","year":"2021","journal-title":"Implement Sci"},{"key":"key2026033107571800_ref134-bib134","doi-asserted-by":"crossref","first-page":"7","DOI":"10.1186\/s13012-018-0851-5","article-title":"Barriers and facilitators of pediatric shared decision-making: a systematic review","volume":"14","author":"Boland","year":"2019","journal-title":"Implement Sci"},{"key":"key2026033107571800_ref135-bib135","doi-asserted-by":"crossref","first-page":"e114","DOI":"10.3399\/bjgp16X683509","article-title":"Barriers to effective management of type 2 diabetes in primary care: qualitative systematic review","volume":"66","author":"Rushforth","year":"2016","journal-title":"Br J Gen Pract"},{"key":"key2026033107571800_ref136-bib136","doi-asserted-by":"crossref","first-page":"e0136202","DOI":"10.1371\/journal.pone.0136202","article-title":"Barriers and facilitators for type-2 diabetes management in south Asians: a systematic review","volume":"10","author":"Sohal","year":"2015","journal-title":"PLOS ONE"},{"key":"key2026033107571800_ref137-bib137","doi-asserted-by":"crossref","first-page":"20","DOI":"10.1186\/s12966-017-0472-4","article-title":"Impact of universal interventions on social inequalities in physical activity among older adults: an equity-focused systematic review","volume":"14","author":"Lehne","year":"2017","journal-title":"Int J Behav Nutr Phys Act"},{"key":"key2026033107571800_ref138-bib138","doi-asserted-by":"crossref","first-page":"e13438","DOI":"10.1111\/obr.13438","article-title":"A systematic review of inequalities in the uptake of, adherence to, and effectiveness of behavioral weight management interventions in adults","volume":"23","author":"Birch","year":"2022","journal-title":"Obes Rev"},{"key":"key2026033107571800_ref140-bib140","doi-asserted-by":"crossref","first-page":"9890231","DOI":"10.1177\/2150132719890231","article-title":"Patient engagement survey regarding future double-blinded, randomized controlled trial of tapering of chronic opioid therapy","volume":"10","author":"James","year":"2019","journal-title":"J Prim Care Community Health"},{"key":"key2026033107571800_ref141-bib141","doi-asserted-by":"crossref","first-page":"103","DOI":"10.1186\/s13012-018-0789-7","article-title":"Barriers and facilitators to implementing evidence-based interventions among third sector organisations: a systematic review","volume":"13","author":"Bach-Mortensen","year":"2018","journal-title":"Implement Sci"}],"container-title":["Health Technology Assessment"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/njl-admin.nihr.ac.uk\/document\/download\/2050650","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.journalslibrary.nihr.ac.uk\/sites\/journalslibrary\/files\/journal_data\/GDWP3572\/GDWP3572.xml","content-type":"text\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/njl-admin.nihr.ac.uk\/document\/download\/2050650","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,3,31]],"date-time":"2026-03-31T02:31:11Z","timestamp":1774924271000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.journalslibrary.nihr.ac.uk\/hta\/GDWP3572"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,3]]},"references-count":135,"alternative-id":["10.3310\/GDWP3572"],"URL":"https:\/\/doi.org\/10.3310\/gdwp3572","relation":{},"ISSN":["2046-4924"],"issn-type":[{"value":"2046-4924","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,3]]},"assertion":[{"value":"This content has been made freely available to all.","name":"free","label":"Free to read"},{"value":"09-2020","name":"contractual_start_date","label":"contractual_start_date","group":{"name":"article_history","label":"Article History"}},{"value":"07-2023","name":"editorial_review_begun","label":"editorial review begun","group":{"name":"article_history","label":"Article History"}},{"value":"10-2024","name":"accepted_for_publication","label":"Accepted for publication","group":{"name":"article_history","label":"Article History"}}]}}