The aim of this research was to investigate stakeholders’ perspectives on facilitators and barriers of opioid optimisation for patients with chronic non-malignant pain (CNMP) and use the insights gained to inform a proposed intervention. A systematic review of previous interventions was complemented by three linked qualitative studies with different stakeholder populations. Study 1 involved semi-structured interviews informed by the Theoretical Domains Framework (TDF) with 22 community pharmacists. Study 2 collected data on patients’ perspectives from their posts’ online discussion forums. In study 3, semi-structured interviews were conducted with three clinical pharmacists and eight pain consultants in pain clinics. Data in all three studies were analysed thematically using TDF domains as coding categories.

The systematic review revealed heterogeneity in previous interventions’ terminology, methods, target populations and outcomes. They showed a focus on patient behaviour but insufficient consideration of influential psycho-social factors. Study 1 showed pharmacists perceived themselves as guardians of patient welfare but felt hindered in optimisation efforts by a lack of authority, training, and time. Study 2 revealed the life-alerting physical, emotional and social impacts of pain on patients. It highlighted the importance of a supportive relationship with healthcare providers but showed that patients felt unsupported and stigmatized. Study 3 highlighted the importance of individualized, patient-centred, but there were suggestions that some healthcare providers lack the training and knowledge needed to support patients through opioid therapy and tapering.

Based on the synthesised results and using the Behaviour Change Wheel (BCW) as a guide, the proposed intervention was designed with the aim of facilitating optimisation intended to improve providers’ communication skills, reduce stigmatization of CNMP patients, encourage shared decision making and facilitate patient education on opioids via provider education and training, persuasion and modelling, in a blended learning programme. This should lead to more appropriate, individualized prescribing and tapering decisions and patients feeling understood and supported, leading to better compliance with treatment.