It Is a Pain to Take Care of Pain

While many studies have looked at the treatment of chronic pain from the patient's perspective, there has been little research on those who provide care for chronic pain. A new study reports that chronic pain takes a toll on primary care providers as well as their patients. They conclude that providers' needs should not be ignored if pain care is to be improved.

Most chronic pain is treated by primary care providers and necessitates frequent interactions with the patient. In this study the researchers surveyed 20 primary care providers (15 physicians, four nurse practitioners and one pharmacist) with varying clinical experience in the Roudebush VA Medical Center in Indianapolis. All ten men and ten women were asked open-ended questions designed to elicit their experiences with chronic pain management.

"Many providers criticized themselves because they felt unable to treat chronic pain effectively. Many internalized their lack of success with pain treatment, felt stress, and had guilty feelings. These negative feelings were compounded by hostile interactions with some patients, suspicions and distrust of some patients, especially those they suspected might be seeking pain medications for uses other than pain control, or to sell," said study first author Marianne Matthias.

Unlike other symptoms, such as elevated blood pressure or cholesterol readings, pain is subjective without any objective tests to confirm. One individual might rate pain a four on a one to ten pain scale; another might label the same degree of pain a six or a seven.

While high blood pressure and cholesterol often can be lowered with medication; successful treatment of chronic pain - especially pain for which there is no known cause - can be elusive, which is frustrating to both patients and care providers and can put a strain on their relationship, which can ultimately impact both patients' and providers' well-being.

The study authors conclude that strategies to ease frustrations and defuse potential hostility in clinical interactions will ultimately improve pain management from the perspectives of both patients and providers. However they also note that potential solutions to difficulties in chronic pain care extend beyond the individual provider.

The culture of the organizations - for example if there is pressure to prescribe or not to prescribe opioids for chronic pain - in which providers practice play an important role in providers' experiences, potentially making a difference in relationships with chronic pain patients.

MEDICA.de; Source: Indiana University School of Medicine