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Bergman AB, Matthias MS, Coffing JM, Krebs EE. Managing chronic pain with opioid medications: Patient voices. Poster session presented at: Society of General Internal Medicine Annual Meeting; 2012 May 1; Orlando, FL.
MANAGING CHRONIC PAIN WITH OPIOID MEDICATIONS: PATIENT VOICES Alicia A. Bergman1; Jessica Coffing1; Marianne S. Matthias1,2; Erin E. Krebs1,2. 1Roudebush VAMC, Indianapolis, IN; 2Indiana University School of Medicine, Indianapolis, IN. (Control ID #1342335) BACKGROUND: Over the past two decades opioid prescribing for chronic pain has increased dramatically, along with rates of opioid abuse and opioid-related overdose deaths. National guidelines stress that health care providers should monitor for opioid effectiveness, adverse effects, adherence, and signs of misuse, addiction, or diversion among patients on opioid therapy. Some monitoring strategies, such as contracts and urine screening, have potentially punitive undertones and may have unintended alienating or stigmatizing effects. The goal of this qualitative study was to develop a better understanding of the experiences, perceptions, and challenges patients with chronic pain face when communicating with their primary care physicians about opioid therapy and monitoring. METHODS: Semi-structured interviews were conducted with 24 patients from a federally funded hospital in the Midwest. Purposive and snowball sampling techniques were first used to identify 14 primary care physicians, who then provided lists from which patients were randomly identified. All of the patients were receiving long-term opioids for chronic pain. RESULTS: Qualitative thematic analysis of the interviews revealed three major themes: 1) avoiding opioids; 2) wanting pain to be acknowledged; and 3) treating patients as individuals. Wanting to avoid opioids was one of the most common themes and was overwhelmingly driven by patient fears of addiction, although other reasons included side effects, as well as how opioids limit daily functioning and cover up underlying symptoms. Patients discussed their initial discomfort with starting opioids and their desires to taper off of them or stop them completely. As one patient described, "You prescribe pain medicine, you just started a junkie." Another patient recalled, "each one of them [opioids] I took myself off of..like, I'm not gonna become a dope addict, you know, because of pain." The second theme of wanting pain to be acknowledged deals to a large extent with how the patients often did not feel as though the physicians wanted to hear about their experience of pain or talk about it during the appointment. As one patient said, "I mean they don't really ask you how, you know, 'what's your problems'. she [current doctor] never really wanted to listen to what I tell her. And I'm like, 'well, I'm trying to explain to you that I'm hurting, you know.' It's like, 'what do you want me to do?' That's her words, 'what do you want me to do?'" The third theme was related to patients wanting their physicians to treat them as individuals, as opposed to being stereotyped (e.g., assuming patients are addicts based on "that one bad apple" as put by one patient), or lumped into broad categories when it comes to prescribing. As stated by another patient, "everything needs to be on a. one-to-one, on a personal basis, no matter what it is." CONCLUSIONS: Gaining in-depth knowledge about patients' struggles with opioid therapy is an important step in creating interventions that help both patients and providers with chronic pain management. Important implications for clinical practice from this study include specific strategies for how primary care physicians can approach patients.
