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: 2.24). 11/2010; 11(11):1688-97. DOI: 10.1111/j.1526-4637.2010.00980.x
Source: PubMed

ABSTRACT 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.

  • Source
    • "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"
    [Show abstract] [Hide abstract]
    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
  • Source
    • "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. "
    [Show abstract] [Hide abstract]
    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.
    Australian Journal of Primary Health 04/2012; DOI:10.1071/PY11154 · 1.22 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: To understand primary care providers (PCPs)' experiences, beliefs, and attitudes about using opioid treatment agreements (OTAs) for patients with chronic pain. Qualitative research study. Twenty-eight internists and family medicine physicians at two health centers. Semistructured telephone interviews, informed by the Integrative Model of Behavioral Prediction. Themes were analyzed using a Grounded Theory approach, and similarities and differences in themes were examined among OTA adopters, nonadopters, and selective adopters. Participants were 64 percent female and 68 percent white, and practiced for a mean of 9.5 years. Adoption of OTAs varied: seven were adopters, five were nonadopters, and 16 were selective adopters. OTA adoption reflected PCPs' beliefs and attitudes in the following three thematic categories: 1) perceived effect of OTA use on the therapeutic alliance, 2) beliefs about the utility of OTAs for patients or providers, and 3) perception of patients' risk for opioid misuse. PCPs commonly believed that OTAs were useful for physician self-protection, but few believed that they prevent opioid misuse. Selective adopters expressed ambivalent beliefs and made decisions about OTA use for individual patients based on both observed data and a subjective sense of each patient's risk for misuse. Substantial variability in PCP use of OTAs reflects differences in PCP beliefs and attitudes. Research to understand the impact of OTA use on providers, patients, and the therapeutic alliance is urgently needed to guide best practices.
    Journal of opioid management 10(2):95-102. DOI:10.5055/jom.2014.0198
Show more