Chronic pain takes a toll on primary care providers as well as patients

WASHINGTON - A new study has pointed out that chronic pain is takes a toll on primary care providers as well as their patients.

While there are many studies that look at the treatment of chronic pain from the patient’s perspective, there has been little research on those who provide care for chronic pain.

Now, researchers from the Regenstrief Institute, the Indiana University School of Medicine, the IU School of Liberal Arts and the Roudebush VA Medical Center have concluded that providers’ needs should not be ignored if pain care is to be improved.

They 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 10 men and 10 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 10 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 providers often described dread when seeing a patient’s name on their clinic schedule, knowing the interaction was going to be unsuccessful at best, difficult or hostile at worst. They described feeling ineffective and unsuccessful in their ability to treat many of their patients with pain,” said Matthias.

“Interestingly, reports of frustration and negative experiences were present throughout the sample. Even those who were generally positive about their relationships with their patients reported difficulties, distrust and other relational issues at times,” he added.

The authors concluded that strategies to ease frustrations and defuse potential hostility in clinical interactions would ultimately improve pain management from the perspectives of both patients and providers.

However, they also noted 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.

“As an internist who frequently treats patients with chronic pain, I know how debilitating and disheartening chronic pain can be for patients. Clinicians need to work with their patients to give them hope that effective treatment of pain is possible,” said the paper’s senior author, Matthew Bair.

The study is published in the current issue of the journal Pain Medicine. (ANI)