Violence toward chronic pain care providers: A national survey

Abstract

CPCPs were at high risk for violence. Risk factors were older age, male, working part time, and anesthesiology. Risk was highest in the context of opioid management and disability. Discharging patient was the most common risk mitigation. A significant number of physicians carried firearms.

<p>Pain and Evil: From Local Nociception to Misery Following Social Harm</p>

“…Except for aggression and impulsive behavior that may interfere with caregivers of chronic sufferers, 162 the presence of CP does not seem to provoke any specific "bad" behavior, ie, nonrespectful and injurious behavior toward other persons. Such behavior in CP patients is directed inward/ towards themselves, as it is for suicidal ideation or analgesic misuse/abuse or drug dependence.…”

“Those Conversations in My Experience Don’t Go Well”: A Qualitative Study of Primary Care Provider Experiences Tapering Long-term Opioid Medications

“…Providers also described these discussions as uniquely emotionally demanding; some reported actually feeling threatened by patients. This concern is difficult to dismiss in the face of research that shows that half of chronic pain care providers have received threats from patients [33], as well as coverage of the murder of a physician in Indiana, reportedly related to a refusal to prescribe opioid medications [34]. In this open-ended study of primary care providers, this emerged as a theme that warrants additional research, as primary care providers prescribe the majority of opioid medications in this country [35].…”

Violence in the pain clinic: the hidden pandemic

“…It is also more prevalent in high stress inpatient and outpatient environments, such as chronic pain clinics or the intensive care unit 4. In a recent national survey of chronic pain care providers, opioid management conferred the greatest risk factor for violence against clinicians 11. Organizations with inadequately supported safety cultures such as lack of clinician and staff training in WPV prevention and de-escalation training experience higher risks of violent outbursts and present major risks for clinicians 12 13.…”

“…The primary determinant of WPV against pain clinicians was patient dissatisfaction stemming from issues with opioid management and requests for worker’s compensation and disability 8 11. In the pain clinic setting, interventions to mitigate WPV include engaging security personnel (82%) or dismissing patients from further clinical encounters (39%–85%) 8 11. Additionally, up to 25% of pain clinicians carry a weapon or personal security equipment 8 11.…”

“…In the pain clinic setting, interventions to mitigate WPV include engaging security personnel (82%) or dismissing patients from further clinical encounters (39%–85%) 8 11. Additionally, up to 25% of pain clinicians carry a weapon or personal security equipment 8 11. Motives behind carrying a weapon/personal security equipment were not further extrapolated on in this survey; however, fears of being stalked, concern for self-protection and community protection in ‘gun-free zones’, indirect physical threats from patients, and sociopolitical factors may play a role in carrying weapons 28.…”