Treatment of Chronic Pain - Consumer and Provider Conce*

Upshur, Carole

Abstract

Studies have shown that most chronic pain is managed in primary care and that it represents one of the most prevalent patient complaints. Virtually no studies of chronic pain have included adequate samples of low income and minority consumers, yet it is felt that these populations present special challenges in care management due to lack of education, the types of jobs they hold, and other environmental and psychosocial disadvantages. Physicians often report that they receive inadequate training on managing chronic nonmalignant pain and that they feel less confidence and are less satisfied with their management of chronic pain patients. Patients similarly report much less satisfaction with management of chronic pain compared to other health conditions. Further, recent controversies over the street use of effective chronic pain management medications (e.g. oxycontin) have made physicians even less confident and more concerned about how to appropriately treat patients. Using a framework of patient-centered care as the appropriate paradigm to improve chronic nonmalignant pain outcomes, the proposed exploratory study will further knowledge about the unique needs and issues confronted in managing chronic nonmalignant pain through addressing three major questions: 1) In racially diverse and economically disadvantaged primary care populations, what are the concerns and barriers faced by physicians and other primary care providers in delivering quality care to chronic, nonmalignant pain patients?; 2) What are the concerns and barriers about their care management identified by chronic pain patients in these settings and what suggestions do they have for improvements in their chronic pain care .management?; and 3) In what ways do provider and patient concerns and identified barriers converge or diverge and how do these convergences or divergences appear to relate to patient satisfaction and outcomes?