Abstract
Research has largely ignored the systematic examination of physicians' attitudes towards
providing care for patients with chronic noncancer pain. The objective of this study
was to identify barriers and facilitators to opioid treatment of chronic noncancer
pain patients by office-based medical providers. We used a qualitative study design
using individual and group interviews. Participants were 23 office-based physicians
in New England. Interviews were audiotaped, transcribed, and systematically coded
by a multidisciplinary team using the constant comparative method. Physician barriers
included absence of objective or physiological measures of pain; lack of expertise
in the treatment of chronic pain and coexisting disorders, including addiction; lack
of interest in pain management; patients' aberrant behaviors; and physicians' attitudes
toward prescribing opioid analgesics. Physician facilitators included promoting continuity
of patient care and the use of opioid agreements. Physicians' perceptions of patient-related
barriers included lack of physician responsiveness to patients' pain reports, negative
attitudes toward opioid analgesics, concerns about cost, and patients' low motivation
for pain treatment. Perceived logistical barriers included lack of appropriate pain
management and addiction referral options, limited information regarding diagnostic
workup, limited insurance coverage for pain management services, limited ancillary
support for physicians, and insufficient time. Addressing these barriers to pain treatment
will be crucial to improving pain management service delivery.
Perspective
This article demonstrates that perceived barriers to treating patients with chronic
noncancer pain are common among office-based physicians. Addressing these barriers
in physician training and in existing office-based programs might benefit both noncancer
chronic pain patients and their medical providers.
Key words
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Article info
Publication history
Published online: June 02, 2010
Accepted:
April 8,
2010
Received in revised form:
April 6,
2010
Received:
March 2,
2010
Footnotes
Primary support for this project was a Robert Wood Johnson Foundation Generalist Physician Faculty Scholar Award to Dr. Fiellin. Dr. Sullivan was supported by the National Institute on Drug Abuse (NIDA) Physician Scientist Award (K12 DA00167). Dr. Sullivan was a Robert Wood Johnson Foundation Physician Faculty Scholar during the conduct of this study. This work was also supported by grants from NIDA to Dr. Barry (K23 DA024050-02), Dr. Schottenfeld (K24 DA000445-03 and R01 DA009803-07) and Dr. Fiellin (RO1 DA020576-01, RO1 DA019511-03).
Identification
Copyright
© 2010 American Pain Society. Published by Elsevier Inc. All rights reserved.
