Doctors and patients in pain: Conflict and collaboration in opioid prescription in primary care |
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| Affiliation: | 1. Alpert Medical School of Brown University, Providence, RI, USA;2. Department of Family Medicine, Alpert Medical School of Brown University, Providence, RI, USA;1. Pain Research Laboratory, Institute of Nautical Medicine, Jiangsu Key Laboratory of Inflammation and Molecular Drug Target, Nantong University, Nantong, Jiangsu, China;2. Department of Nutrition, School of Public Health, Nantong University, Nantong, Jiangsu, China;3. Departments of Anesthesiology and Neurobiology, Duke University Medical Center, Durham, NC 27710, USA;1. Department of Pharmacological and Physiological Science, Saint Louis University School of Medicine, 1402 South Grand Blvd, St Louis, MO 63104, USA;2. Department of Clinical and Experimental Medicine and Pharmacology, University of Messina, Messina 98122, Italy;3. Molecular Recognition Section, Laboratory of Bioorganic Chemistry, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD 20892-0810, USA;1. Danish Pain Research Center, Aarhus University, Aarhus, Denmark;2. Department of Neurology, Aarhus University Hospital, Aarhus, Denmark;1. Department of General Practice, Institute of Health and Society, University of Oslo, Oslo, Norway;2. Department of Community Medicine, Institute of Health and Society, University of Oslo, Norway;3. Division of Epidemiology, Norwegian Institute of Public Health, Oslo, Norway;1. Department of Neurosciences, School of Medicine and Dentistry, University of the Basque Country, Bilbao, Spain;2. Movement Disorders and Autonomic Unit, Neurology Service, Cruces University Hospital, Basque Health Service (Osakidetza), Spain;1. GlaxoSmithKline Clinical Unit Cambridge, Addenbrooke’s Centre for Clinical Investigation, Addenbrooke’s Hospital, Cambridge, UK;2. GlaxoSmithKline, Brentford, UK;3. GlaxoSmithKline, Stevenage, UK;4. GlaxoSmithKline, Verona, Italy |
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| Abstract: | Use of chronic opioid therapy (COT) for chronic noncancer pain has dramatically increased in the United States. Patients seek compassionate care and relief while physicians struggle to manage patients’ pain effectively without doing harm. This study explores the narratives of chronic noncancer pain patients receiving chronic opioid therapy and those of their physicians to better understand the effects of COT on the doctor–patient relationship. A mixed method study was conducted that included in-depth interviews and qualitative analysis of 21 paired patients with chronic pain and their physicians in the following groups: patients, physicians, and patient–physician pairs. Findings revealed that patients’ narratives focus on suffering from chronic pain, with emphasis on the role of opioid therapy for pain relief, and physicians’ narratives describe the challenges of treating patients with chronic pain on COT. Results elucidate the perceptions of ideal vs difficult patients and show that divergent patterns surrounding the consequences, utility, and goals of COT can negatively affect the doctor–patient relationship. The use of paired interviews through a narrative lens in this exploratory study offers a novel and informative approach for clinical practice and research. The findings have significant implications for improving doctor–patient communication and health outcomes by encouraging shared decision making and goal-directed health care encounters for physicians and patients with chronic pain on COT.PerspectiveThis study found patterns of understanding pain, opioid pain medications, and the doctor–patient relationship for patients with chronic pain and their physicians using a narrative lens. Thematic findings in this exploratory study, which include a portrayal of collaborative vs conflictual relationships, suggest areas of future intervention and investigation. |
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| Keywords: | Chronic noncancer pain Chronic opioid therapy Doctor–patient relationship Narrative medicine Opiate epidemic Pain management |
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