Communicating about opioids for chronic pain: A qualitative study of patient attributions and the influence of the patient–physician relationship

Abstract

Background: Chronic pain poses numerous challenges for patients and providers, particularly when opioid treatment is discussed. Despite accounts of antagonistic patient-provider communication, little is known about how communication about opioids unfolds during clinic visits and, importantly, how the relationship history of a patient and physician shapes this communication. This study's objective was to advance understanding of communication about opioid treatment by recording primary care clinic visits and conducting in-depth interviews with patients to gain insight into the patient-provider relationship and its influence on clinical communication. Methods: Forty patients with chronic pain were audio recorded during their primary care clinic appointments and then interviewed about their pain care and relationships with their providers. Ten patients were excluded from analysis because pain was not discussed during the clinic visit. Results: Qualitative analysis revealed that patients responded in markedly different ways to similar physician treatment decisions about opioids. Some patients attributed limiting or denying opioids to physicians' distrust or lack of caring. Others attributed these limitations to acting out of genuine concern for patients' health. These attributions appeared to be shaped by features of the patient-physician relationship as described by patients. Results are discussed within the framework of attribution theory. Conclusions: Understanding how patients and providers discuss opioid treatment is critical for optimal pain treatment. Physicians might be able to improve communication by re-framing treatment discussions about opioids around external factors, such as benefits and harms, and engaging in communication that fosters a strong therapeutic alliance and emphasizes concern for the patient.

Barriers to Guideline-Concordant Opioid Management in Primary Care—A Qualitative Study

“…5 In a prior study (conducted in the same setting with different participants), we similarly found that many patients had positive beliefs about physicians' decisions to limit opioid use. 19 Patients often placed these decisions in the context of their physicians' past concern and support, attributing even disappointing decisions about opioids to their doctor's concern for their health. These findings lend support to recent arguments that the focus of opioid management should shift from detecting ''risky patients'' to managing ''risky drugs.''…”

“I'm Not Gonna Pull the Rug out From Under You”: Patient-Provider Communication About Opioid Tapering

“…Because pain and opioid management are communicative activities and this communication is sometimes challenging, 22–24,31 it is critical to learn more about how tapering occurs. These lessons learned will help to inform future clinical communication about tapering, to optimize patients’ understanding of and experiences with tapering, and to avoid unintended negative consequences.…”

“…For example, when doctors showed genuine concern for their patients’ health and well-being, patients with chronic pain seemed more willing to accept decisions to limit or deny opioids. 22 In a recent study involving interviews with patients being tapered off of opioids, Frank and colleagues 13 reported that patients believed having a trusted physician was essential. Studies have shown that when patients and their PCPs have similar concerns about opioids, they can approach these concerns collaboratively.…”

Facilitators and Barriers to Participation in a Peer Support Intervention for Veterans With Chronic Pain

“…These competing demands and time constraints decrease the time available to discuss pain concerns. 8,9 Third, self-management interventions in a healthcare setting frequently involve nurse care managers, pain psychologists, social workers, and other healthcare professionals who deliver self-management instruction and provide follow-up to patients, which allows for tailored delivery of relevant information. 7,10,11 However, such professionals are not always readily available in clinics, and individualized attention is resource intensive.…”