Beyond pain & meds:

Paired interviews of chronic pain patients on chronic opioid therapy (COT) and their

physicians

Angela Yang, AMSII

How do long-term narcotics for chronic pain patients affect the doctor-patient relationship?

Collect narratives: Interview patients and physicians pairs

Analyze (ongoing) : identify themes, patterns, areas of convergence and mismatch

Identify/explore barriers to good communication and compassionate care (ongoing)

Brainstorm: How can the doctor be a more effective communicator and advocate for chronic pain patients on

COT? How do we bridge these gaps? What resources need to be developed for both patients and physicians ?

Interventions/solutions

Overview

How? Patients recruited through their physicians at the Family Care Center (FCC) of Memorial Hospital Where? 11 home visits, 10 at FCCWho?

21 chronic non malignant pain patients 16 physicians (of all levels of

training)What?

The In-depth Interview:I.PainII.Pain medsIII. Relationship with Doctor

Questionnaires : SF- 12, Graded Chronic Pain Scale 2.0, Prescribed Opioid Difficulties Scale, and a pictorial depiction of pain.

Collecting narratives

Patient Demographics

Age 24-62

Sex

Male 8

Female 13

Employment/disability

SSID 15

Employed 4

Unemployed 2

Marital Status

Single 11

Married 3

Divorced 6

Widowed 1

Total 21

Initial results

Patients:•Suffering from chronic pain•Role of opioid therapy for pain relief •Reliance on physicians for pain management

Physicians •Many challenges of treating chronic pain patients on COT

• Subjectivity of pain • Problems such as

diversion and dishonesty•Lack of effective therapies for pain•Concerns of harming patients by enabling an addiction

***Interviews are being examined for important themes, patterns, and major areas of convergence, and divergence/mismatch in the following groups: patients, physicians, and patient-physician pairs.

Pain confines both patients and physicians immeasurably Patients and physicians share a strong desire to improve

patient functionality and to find pain relief but long-term goals and outcomes are often unclear or unaddressed

Divergent patterns on the consequences, utility, and goals of COT underlie its impact on the doctor-patient relationship.

My current focus: the dialogue and tensions that derive from pain meds and perceptions about addiction

Unmet goals/weaknesses of the project thus far

I’m learning that …

What’s to come: ideas for healing interactions

• Medical education: students visiting chronic pain patients

• Potential interventions: chronic pain patient support groups module for physicians handout for chronic pain patients on

COT chronic pain patient advocate/counselor

• Art/prose/poetry pieces that give both patients and doctors a voice

Much gratitude to:

•Jeffrey Borkan, MD, PhD, Department of Family Medicine, AMS•Irene Reis, Administrative Assistant, Dept. of Family Medicine•Dr. Schraeder, Physician as Communicator SC• Memorial Hospital FCC: residents, attendings, & staff• Patients• Friends- Green Tea analysis team• And RI AHEC for support to make this research journey possible!

Thank you!!!

Questions? Suggestions?

email: angela_yang@brown.edu