Webinar Paul van Wilgen en Eglantyne Hoekstra: Afhankelijk van opioïden? Daar moet je snel van af als je chronische pijn hebt!: 01 June 2022

Chronic Pain and Opioid Dependence: Physiotherapeutic Approach to Tapering

Chronic pain and opioid use frequently go hand in hand. In the Netherlands, more than one million people are prescribed opioids annually — and one in five uses them for longer than three months. For patients with nociplastic pain (central sensitisation), however, opioids are counterproductive: they increase pain sensitivity, promote anxiety and depression, and impede recovery. Physiotherapists play a crucial role both in recognising this pattern and in supporting patients through tapering.

In this Incitus webinar, Prof. dr. C. Paul van Wilgen and nurse practitioner Eglantyne Hoekstra guide you through the complete care pathway: from recognising central sensitisation and the sustaining role of opioids, through pain neuroscience education and motivational interviewing, to graded activity, graded exposure and transdisciplinary collaboration with physicians and psychologists. An extensive interactive case study is included.

There has also been a significant increase in the Netherlands in the number of patients using opioids long-term. Oxycodone, in particular, has been widely prescribed, including to patients with chronic pain. Long-term opioid use is not indicated for chronic pain. Prolonged opioid use in patients with chronic pain leads to many adverse side effects and often to increased pain sensitivity (allodynia and hyperalgesia).

It is therefore essential to motivate patients to taper off this medication. In this webinar, we discuss the clinical process of opioid tapering, including best-practice interventions. Recommended treatments include pharmacological approaches, motivational interviewing, cognitive behavioural therapy, and contingency management. A guideline for tapering legally prescribed opioids in patients with chronic pain is still under development.

What we will cover in the webinar:

• Why opioids are counterproductive in nociplastic pain

• Recognising central sensitisation: four diagnostic criteria for physiotherapists

• Pain neuroscience education and graded activity in opioid tapering

• Transdisciplinary collaboration: the physiotherapist's role in the care team

• Case study: from opioid dependence to full functional recovery

Learning Goals

The student is able to critically analyse and clinically justify the role of opioids as a maintaining factor in chronic pain, and translate this into a reasoned treatment strategy within a biopsychosocial framework.

The student is able to critically differentiate and interpret pain mechanisms in complex and ambiguous clinical presentations, and evaluate their implications for diagnosis and treatment decisions.

The student is able to design, justify and adapt a transdisciplinary treatment plan integrating biopsychosocial factors, shared decision-making, and interprofessional collaboration.

The student is able to independently evaluate and manage the consequences of opioid tapering using structured monitoring and risk-sensitive clinical reasoning.

The student is able to apply advanced communication strategies to manage resistance, facilitate behavioural change, and support adherence during opioid reduction.