The Patient-Provider Relationship in Chronic Pain Care: Providers' Perspectives

VA Health Services Research and Development Center of Excellence on Implementation of Evidence-Based Practices, Roudebush VAMC, Indianapolis, IN 46202, USA.
Pain Medicine (Impact Factor: 2.3). 11/2010; 11(11):1688-97. DOI: 10.1111/j.1526-4637.2010.00980.x
Source: PubMed


Pain is the most commonly reported symptom in primary care and is a leading cause of disability. Primary care providers (PCPs) face numerous challenges in caring for patients with chronic pain including communication and relational difficulties.
The objective of the study was to elicit providers' perspectives on their experiences in caring for patients with chronic pain.
The design used was a qualitative study using open-ended, in-depth interviews.
Twenty providers (10 men, 10 women) from five different clinics were interviewed at the Roudebush Veterans Affairs Medical Center.
Three broad themes emerged from the analysis: 1) providers emphasized the importance of the patient-provider relationship, asserting that productive relationships with patients are essential for good pain care; 2) providers detailed difficulties they encounter when caring for patients with chronic pain, including feeling pressured to treat with opioids, believability of patients' reports of pain, worries about secondary gain/diversion, and "abusive" or "difficult" patients; and 3) providers described the emotional toll they sometimes felt with chronic pain care, including feeling frustrated, ungratified, and guilty.
Findings were interpreted within a model of patient-centered care.
The clinical implications of these findings are two-fold. First, PCPs' needs cannot be ignored when considering pain care. PCPs need support, both instrumental and emotional, as they care for patients with chronic pain. Second, improving PCPs' patient-centered communication skills-including demonstrating empathy and encouraging shared decision-making-holds promise for alleviating some of the strain and burden reported by providers, ultimately leading to improved patient care.

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    • "Continuous Quality Improvement (CQI) models of healthcare emphasize the importance of acknowledging the perspectives of all treatment team members involved in patient care as the first step in improving healthcare delivery [22]. Pain is a complex medical condition, and the knowledge generated from research on the perspectives of providers and patients solely is not enough to fully address system difficulties [23, 24]. By better understanding the perspectives of RNs and HTs, we hope to inform the efforts to improve the delivery of collaborative pain care within the PCC and across the continuum of specialty and tertiary care. "
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    ABSTRACT: Recent national estimates from the U.S. reveal that as many as one-third of all Americans experience chronic pain resulting in high prevalence rates of visits to primary care clinics (PCC). Indeed, chronic pain appears to be an emerging global health problem. Research has largely ignored the perspective of PCC staff other than physicians in providing care for patients with chronic pain. We wanted to gain insights from the experiences of Registered Nurses (RNs) and Health Technicians (HTs) who care for this patient population. Krippendorff's method for content analysis was used to analyze comments written in an open-ended survey from fifty-seven primary care clinic staff (RNs-N=27 and HTs-N=30) respondents. This represented an overall response rate of 75%. Five themes emerged related to the experience of RNs and HTs caring for patients with chronic pain: 1) Primacy of Medications and Accompanying Clinical Quandaries; 2) System Barriers; 3) Dealing with Failure; 4) Primacy of Patient Centered Care; and 5) Importance of Team Based Care. This study demonstrates that nursing staff provide patient-centered care, recognize the importance of their role within an interdisciplinary team and can offer valuable insight about the care of patients with chronic pain. This study provides insight into strategies that can mitigate barriers to chronic pain management while sustaining those aspects that RNs and HTs view as essential for improving patient care for this vulnerable population in PCCs.
    The Open Nursing Journal 09/2014; 8(1):25-33. DOI:10.2174/1874434601408010025
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    • "ay become tired of repeated attempts to draw empathy by those experiencing pain , and it is this longer term outcome which demonstrates the dysfunctional elements of self - harm . This same " empathy drain " may be evident in cases of chronic pain , where observers feel they can no longer con - tinue to empathize with another individual ' s pain ( Matthias et al . , 2010 ) . Indeed , research suggests that empathy for pain " hurts " because it activates both the sensory and affective components of pain experience ( Loggia , Mogil , & Bushnell , 2008 ) . Work on pain catastrophizing in chronic pain patients provides evidence for a positive relationship between the extent of catastrophizing behavior and t"
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    ABSTRACT: Pain is mostly thought of as a problem-as debilitating or harmful. Despite its unpleasantness, however, under some conditions pain can be associated with positive consequences. In this review, we explore these positive biological, psychological, and social consequences of pain. We highlight three different domains in which pain may be considered to have positive consequences. First, pain facilitates pleasure by providing an important contrast for pleasurable experiences, increasing sensitivity to sensory input, and facilitating self-rewarding behavior. Second, pain augments self-regulation and enhancement by increasing cognitive control, reducing rumination, and demonstrating virtue. Third, pain promotes affiliation by arousing empathy from others, motivating social connection, and enhancing group formation. Drawing on evidence scattered across a range of academic fields, we provide for reflection on how pain is represented, generate insights into pain-seeking behavior, and draw attention to the role of painful experiences in maximizing positive outcomes.
    Personality and Social Psychology Review 04/2014; 18(3). DOI:10.1177/1088868314527831 · 7.55 Impact Factor
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    • "Whether GPs are the best primary health practitioner to provide this point of contact is unclear. A recent Canadian study concluded that primary care providers find patients with chronic pain to be a major source of frustration, and practitioners may internalise what they consider their lack of success with this patient group in terms of feeling guilty, ineffective and ungratified (Matthias et al. 2010). Exploring this issue with Australian primary health providers would be a worthwhile topic for future research. "
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    ABSTRACT: Chronic pain is a commonly reported problem in primary care, and is Australia's third most costly health problem. Despite advances in the understanding and treatment of pain, many people with chronic pain do not receive the best available care. This paper examines the health care experiences of people with chronic pain and focuses discussion on the impact that institutional and cultural factors can have on individual experience. Unstructured narrative interviews were conducted with a convenience sample of 20 people with chronic pain. Participants' experiences pointed to several factors that can affect the outcome of the health care they receive, including: the belief that all pain is due to identifiable injury or disease; a commitment to finding a diagnosis and cure; problematic patientÀprovider communication; and poor integration of health services. Comprehensively addressing these factors cannot be achieved by focusing interventions at the individual level. A multifaceted response, which includes public health and systemic initiatives, is required. Additional keywords: social environment, qualitative.
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