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Pain Med. 2010 Nov;11(11):1688-97. doi: 10.1111/j.1526-4637.2010.00980.x.

The patient-provider relationship in chronic pain care: providers' perspectives.

Author information

  • 1VA Health Services Research and Development Center of Excellence on Implementation of Evidence-Based Practices, Roudebush VAMC, Indianapolis, IN 46202, USA. mmatthia@iupui.edu

Abstract

BACKGROUND:

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.

OBJECTIVE:

The objective of the study was to elicit providers' perspectives on their experiences in caring for patients with chronic pain.

DESIGN:

The design used was a qualitative study using open-ended, in-depth interviews.

PARTICIPANTS:

Twenty providers (10 men, 10 women) from five different clinics were interviewed at the Roudebush Veterans Affairs Medical Center.

RESULTS:

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:

Findings were interpreted within a model of patient-centered care.

CONCLUSIONS:

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.

Wiley Periodicals, Inc.

PMID:
21044259
[PubMed - indexed for MEDLINE]
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