“Is there any way I can get something for my pain?” Patient strategies for requesting analgesics

Buchbinder, Mara; Wilbur, Rachel E.; McLean, Samuel A.; Sleath, Betsy

doi:10.1016/j.pec.2014.10.021

Cited by 17 publications

(18 citation statements)

References 42 publications

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“…The duration of back pain was either undefined or mixed in 39 (78%) studies[ 24 , 25 , 37 – 43 , 45 – 47 , 50 , 51 , 55 – 65 , 67 – 69 , 72 – 77 , 79 – 81 , 83 , 84 ] . While 11 (22%) studies reported on chronic back pain (>12 weeks duration)[ 44 , 48 , 49 , 52 – 54 , 66 , 70 , 71 , 78 , 82 ].there were no studies on acute back pain alone (<6 weeks duration).…”

Section: Resultsmentioning

confidence: 99%

Patients’ perceived needs for medical services for non-specific low back pain: A systematic scoping review

et al. 2018

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BackgroundAn improved understanding of patients’ perceived needs for medical services for low back pain (LBP) will enable healthcare providers to better align service provision with patient expectations, thus improving patient and health care system outcomes. Thus, we aimed to identify the existing literature regarding patients’ perceived needs for medical services for LBP.MethodsA systematic scoping review was performed of publications identified from MEDLINE, EMBASE, CINAHL and PsycINFO (1990–2016). Descriptive data regarding each study, its design and methodology were extracted and risk of bias assessed. Aggregates of patients’ perceived needs for medical services for LBP were categorised.Results50 studies (35 qualitative, 14 quantitative and 1 mixed-methods study) from 1829 were relevant. Four areas of perceived need emerged: (1) Patients with LBP sought healthcare from medical practitioners to obtain a diagnosis, receive management options, sickness certification and legitimation for their LBP. However, there was dissatisfaction with the cursory and superficial approach of care. (2) Patients had concerns about pharmacotherapy, with few studies reporting on patients’ preferences for medications. (3) Of the few studies which examined the patients’ perceived need of invasive therapies, these found that patients avoided injections and surgeries (4) Patients desired spinal imaging for diagnostic purposes and legitimation of symptoms.ConclusionsAcross many different patient populations with data obtained from a variety of study designs, common themes emerged which highlighted areas of patient dissatisfaction with the medical management of LBP, in particular, the superficial approach to care perceived by patients and concerns regarding pharmacotherapy. Patients perceive unmet needs from medical services, including the need to obtain a diagnosis, the desire for pain control and the preference for spinal imaging. These issues need to be considered in developing approaches for the management of LBP in order to improve patient outcomes.

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Section: Resultsmentioning

confidence: 99%

Patients’ perceived needs for medical services for non-specific low back pain: A systematic scoping review

et al. 2018

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“…Studies have shown that when patients and their PCPs have similar concerns about opioids, they can approach these concerns collaboratively. 4,16,23 Collaboration and trust are especially important as nonopioid treatments are explored and as patients face fears of opioid withdrawal or uncontrolled pain. Indeed, in Frank and colleagues’ 13 interviews, patients revealed that withdrawal and uncontrolled pain were major barriers to opioid tapering.…”

Section: Discussionmentioning

confidence: 99%

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

Matthias

Johnson

Shields

et al. 2017

The Journal of Pain

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In response to increases in harms associated with prescription opioids, opioid prescribing has come under greater scrutiny, leading many health care organizations and providers to consider or mandate opioid dose reductions (tapering) for patients with chronic pain. Communicating about tapering can be difficult, particularly for patients receiving long-term opioids who perceive benefits and are using their medications as prescribed. Because of the importance of effective patient–provider communication for pain management and recent health system-level initiatives and provider practices to taper opioids, this study used qualitative methods to understand communication processes related to opioid tapering, to identify best practices and opportunities for improvement. Up to 3 clinic visits per patient were audio-recorded, and individual interviews were conducted with patients and their providers. Four major themes emerged: 1) explaining—patients needed to understand individualized reasons for tapering, beyond general, population-level concerns such as addiction potential, 2) negotiating—patients needed to have input, even if it was simply the rate of tapering, 3) managing difficult conversations—when patients and providers did not reach a shared understanding, difficulties and misunderstandings arose, and 4) nonabandonment—patients needed to know that their providers would not abandon them throughout the tapering process.

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“…Non-antibiotic recommendations are also treated by American physicians as less preferred as evidenced by the fact that they more frequently include accounts (e.g., "Her throat doesn't look too bad") and minimizations (e.g., "I'd just give her Ibuprofen") (Stivers, 2005a;Mangione-Smith et al, 2006). However, there has been no systematic analysis of patients' and physicians' enacted orientations towards prescription versus OTC treatment during adult primary care consultations in the United States or United Kingdom (but see Buchbinder et al, 2015 on patient requests for painkillers; Stevenson et al, 2003 on the acceptability of discussions of selftreatment).…”

Section: Closing the Deal: A Cross-cultural Comparison Of Treatment Rmentioning

confidence: 99%

Closing the Deal: A Cross-Cultural Comparison of Treatment Resistance

Bergen

Stivers

Barnes³

et al. 2017

Health Communication

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This study investigates patient resistance to doctors' treatment recommendations in a cross-national comparison of primary care. Through this lens, we explore English and American patients' enacted priorities, expectations, and assumptions about treating routine illnesses with prescription versus over-the-counter medications. We perform a detailed analysis of 304 (American) and 393 (English) naturally occurring treatment discussions and conclude that American and English patients tend to use treatment resistance in different prescribing contexts to pursue different ends. While American patients are most likely to resist recommendations for non-prescription treatment and display an expectation for prescription treatment in these interactions, English patients show a high level of resistance to recommendations for all types of treatment and display an expectation of cautious prescribing. These behavioral trends reflect broader structural forces unique to each national context and ultimately maintain distinct cultural norms of good-practice prescribing.

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“Is there any way I can get something for my pain?” Patient strategies for requesting analgesics

Cited by 17 publications

References 42 publications

Patients’ perceived needs for medical services for non-specific low back pain: A systematic scoping review

Patients’ perceived needs for medical services for non-specific low back pain: A systematic scoping review

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

Closing the Deal: A Cross-Cultural Comparison of Treatment Resistance

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