December 22, 2010

Patients & Providers Share The Pain

(Ivanhoe Newswire) -- There have been handfuls of studies looking at the treatment of chronic pain from the patient's perspective, but little on those who actually provide that care for chronic pain.  Well, that was until now.  This novel study worked through the pain to show that chronic pain actually takes a toll on primary care providers as well as their patients. The authors conclude that providers' needs should not be overlooked if pain care is to be improved.

In most cases patient's primary physicians treat their chronic pain, which necessitates regular interactions with the patient.  The study surveyed 20 primary care providers "“ 15 physicians, four nurse practitioners and one pharmacist.  All 10 men and 10 women were asked open-ended questions designed to bring out 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," which the study's author Marianne Matthias, Ph.D., a Regenstrief Institute investigator, adjunct assistant professor of communication studies in the IU School of Liberal Arts and a research scientist at the Roudebush VA Medical Center, was quoted as saying.

It is common knowledge that pain is subjective without any objective tests to confirm, unlike symptoms such as elevated blood pressure or cholesterol readings.  A certain individual might say there pain is a five out of 10 on the pain scale, while another would label that same degree of pain an eight.  Despite the fact that high blood pressure and cholesterol often can be lowered with the help of medication; successful treatment of chronic pain "“ especially pain for which there is no known cause "“ can be virtually elusive, which is exasperating to both patients as well as care providers and can put a strain on their relationship, which can in due course 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.  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," which Dr. Matthias, a health services researcher, was quoted as saying.

One provider interviewed said, "I beat myself up with it . . . you want to be liked by your patients.  You want to be respected by your peers.  You don't want to personally feel like you are being Cruella Deville by denying taking them out of pain.  Of course, you want to relieve their pain, so I beat myself up.  I feel guilty when these people end up yelling at me, and they do."

Strategies to alleviate some of those frustrations and defuse potential hostility in clinical interactions will furthermore improve pain management from the perspectives of both patients in addition to their providers.  On the other hand, they note that possible solutions to difficulties in chronic pain care extend far beyond the mere individual provider.  The culture of the organizations "“ an example would be if there is pressure to prescribe opioids for chronic pain "“ in which patients play an imperative role in providers' experiences, potentially making changes in the relationship.

"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," which the paper's senior author, Matthew Bair, M.D., a Regenstrief Institute investigator, assistant professor of medicine at the IU School of Medicine and a research scientist at the Roudebush VA Medical Center, was quoted as saying.

SOURCE: Pain Medicine, December 21, 2010