Patient Experiences Navigating Chronic Pain Management in an Integrated Health Care System: A Qualitative Investigation of Women and Men

Driscoll, Mary; Higgins, Diana M.; Heapy, Alicia; Lee, Allison; Haskell, Sally G.

doi:10.1093/pm/pny139

Cited by 36 publications

(38 citation statements)

References 34 publications

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“…Deliberately making time to develop trust in the context of chronic pain involves having the skills to elicit and listen for indirect cues, flawed beliefs, and goals that may motivate the patient. Prior studies indicating that many patients with chronic pain report feeling distrusted and that their symptoms and concerns were dismissed as trivial in interactions with the PCCs and specialists (6,8,24) align with our participants' perception that these effective, but timeconsuming, strategies to build trust are not universal. Many described a shift in approach as they have come to understand chronic pain more fully.…”

Section: Discussionsupporting

confidence: 79%

Primary Care Clinicians’ Beliefs and Strategies for Managing Chronic Pain in an Era of a National Opioid Epidemic

et al. 2020

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BACKGROUND:Little is known about how primary care clinicians (PCCs) approach chronic pain management in the current climate of rapidly changing guidelines and the growing body of research about risks and benefits of opioid therapy. OBJECTIVE: To better understand PCCs' approaches to managing patients with chronic pain and explore implic a ti o n s f o r t e c h n o l o g i c a l a n d a d m i n i s t r a t i v e interventions. DESIGN: We conducted adapted critical decision method interviews with 20 PCCs. Each PCC participated in 1-5 interviews. PARTICIPANTS: PCCs interviewed had a mean of 14 years of experience. They were sampled from 13 different clinics in rural, suburban, and urban health settings across the state of Indiana. APPROACH: Interviews included discussion of participants' general approach to managing chronic pain, as well as in-depth discussion of specific patients with chronic pain. Interviews were audio recorded. Transcripts were analyzed thematically. KEY RESULTS: PCCs reflected on strategies they use to encourage and motivate patients. We identified four associated strategic themes: (1) developing trust, (2) eliciting information from the patient, (3) diverting attention from pain to function, and (4) articulating realistic goals for the patient. In discussion of chronic pain management, PCCs often explained their beliefs about opioid therapy. Three themes emerged: (1) Opioid use tends to reduce function, (2) Opioids are often not effective for long-term pain treatment, and (3) Response to pain and opioids is highly variable. CONCLUSIONS: PCC beliefs about opioid therapy generally align with the clinical evidence, but may have some important gaps. These findings suggest the potential value of interventions that include improved access to research findings; organizational changes to support PCCs in spending time with patients to develop rapport and trust, elicit information about pain, and manage patient expectations; and the need for innovative clinical cognitive support.

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Section: Discussionsupporting

confidence: 79%

Primary Care Clinicians’ Beliefs and Strategies for Managing Chronic Pain in an Era of a National Opioid Epidemic

et al. 2020

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“… 15 , 25 Previous studies of patient experiences in navigating various medical systems to attain pain management services also highlight common sources of frustration, including a lack of coordination among providers, long wait times in getting responses from providers or providers' offices, and practical barriers including inconsistent or difficult access to services or burdensome transportation to and from treatment appointments. 23 , 24 , 70 Effectively fostering patient engagement necessitates regular communication between providers and patients, and their significant others, such as families or employers, so that treatment plans are translated to settings outside of the clinical environment and concerns or frustrations are identified and addressed in a timely manner. In many multidisciplinary treatment programs, these communications have been led by nurses or care coordinators 32 , 83 or rehabilitation providers.…”

Section: Patient Engagement Adherence and Satisfaction With Telementioning

confidence: 99%

Optimizing telehealth pain care after COVID-19

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Langford

Sturgeon

et al. 2020

PAIN

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“…Women living in rural areas have fewer options for health care providers and rely more on one another for support in managing their disease. We chose to center women's chronic illness experience not only to control for gender but also to give voice to women who suffer gender bias in treating their chronic pain (Driscoll et al, 2018;Samulowitz et al, 2018). CLD shares symptomatology and language around pain with other contested illnesses more common in females such as fibromyalgia and historically discredited psychosomatic diseases, seen as malingering, or described as hysteria and neurasthenia (Armentor, 2017;Råheim & Håland, 2006).…”

Section: Introductionmentioning

confidence: 99%

Personal Agency and Community Resilience: Narratives of Women Navigating Health Care With Chronic Lyme Disease

et al. 2021

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Chronic Lyme disease can manifest as a debilitating illness with symptoms that change over time. With its varied presentation, timeline variation, diagnostic difficulty, and lack of definitive treatment, clinical recognition of chronic Lyme disease remains controversial. At the same time, patients face challenges in finding a provider who is supportive and knowledgeable about diagnosing and treating Lyme. We examined the ways the medical system may have affected the lived experiences of chronic Lyme patients. In this article, we communicate the personal, health care, and community illness experiences of 14 women navigating the medical system with chronic Lyme disease through a qualitative community-based participatory research study using interviews and narrative reflection in a rural community setting. The women were interviewed by a researcher living with chronic Lyme disease and the transcripts were analyzed for themes. All participants described navigating multiple allopathic and nonallopathic care modalities to find satisfactory care. They struggled with physical and emotional burdens of chronic, nonlinear illness, as well as disbelief and discrimination by medical providers. Their lives followed patterns of illness and wellness, trust and mistrust of medical treatment, and community connection and disengagement. They learned to become their own advocates to seek affirmative care. They are aware of the controversial nature of their illness, and many have channeled their frustrations into caring for one another through their Lyme community. Women living with controversial diagnoses like chronic Lyme disease experience increased challenges navigating the medical system to find satisfactory care and thus create communities with each other for mutual aid and support. In understanding these challenges, the medical community can improve care for people living with contested chronic illnesses.

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Patient Experiences Navigating Chronic Pain Management in an Integrated Health Care System: A Qualitative Investigation of Women and Men

Cited by 36 publications

References 34 publications

Primary Care Clinicians’ Beliefs and Strategies for Managing Chronic Pain in an Era of a National Opioid Epidemic

Primary Care Clinicians’ Beliefs and Strategies for Managing Chronic Pain in an Era of a National Opioid Epidemic

Optimizing telehealth pain care after COVID-19

Personal Agency and Community Resilience: Narratives of Women Navigating Health Care With Chronic Lyme Disease

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