Provider and patient perspectives on opioids and alternative treatments for managing chronic pain: a qualitative study.
Provider and patient perspectives on opioids and alternative treatments for managing chronic pain: a qualitative study.
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DOI：
10.1186/s12875-016-0566-0
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发表时间：
2017-03-24
影响因子：
2.9
通讯作者：
Deyo RA
中科院分区：
文献类型：
--
作者：
Penney LS;Ritenbaugh C;DeBar LL;Elder C;Deyo RA
目前的文献描述了使用阿片类药物治疗慢性疼痛的局限性和陷阱以及确定替代品的重要性。本研究的目的是确定患者和提供者在获得阿片类药物替代品时面临的实际问题，以及多方如何看待这些问题。收集定性数据，以评估慢性肌肉骨骼疼痛（CMP）的针灸和整脊（A/C）服务的结果，使用结构化的访谈指南与CMP患者（n = 90）和初级保健提供者（PCP）（n = 25）有目的地抽样从管理式医疗保健系统，以及从签约社区A/C提供者（n = 14）。焦点小组和访谈进行了不同的A/C使用历史的CMP患者。计划PCP和合同A/C供应商参加了个别访谈。所有参与者都被问及他们管理慢性疼痛的经验以及对A/C治疗的经验和/或态度。录音被转录并按主题编码。焦点小组/访谈指南的摘要版本包含在附加文件1中。我们确定了阿片类药物用途：（1）对使用阿片类药物管理慢性疼痛的态度;（2）慢性疼痛管理的有限替代选择;（3）A/C护理作为帮助管理疼痛的工具的潜力;（4）围绕慢性疼痛管理的复杂系统。尽管人们对阿片类药物用于疼痛管理普遍不满，但许多实际障碍对其他选择提出了挑战。大多数参与者认为A/C护理有助于短期缓解疼痛。我们发现，时间，期望和计划覆盖范围的问题限制了A/C护理缓解疼痛治疗的潜力。这些结果表明，关于慢性疼痛管理和治疗选择的现实期望的教育，以及使A/C护理更容易获得，可能会使患者和提供者更加满意，并为政策制定者提供重要的投入。ClinicalTrials.gov NCT 01345409，注册日期2011年4月28日本文的在线版本（doi：10.1186/s12875-016-0566-0）包含补充材料，授权用户可以使用。
Current literature describes the limits and pitfalls of using opioid pharmacotherapy for chronic pain and the importance of identifying alternatives. The objective of this study was to identify the practical issues patients and providers face when accessing alternatives to opioids, and how multiple parties view these issues. Qualitative data were gathered to evaluate the outcomes of acupuncture and chiropractic (A/C) services for chronic musculoskeletal pain (CMP) using structured interview guides among patients with CMP (n = 90) and primary care providers (PCPs) (n = 25) purposively sampled from a managed care health care system as well as from contracted community A/C providers (n = 14). Focus groups and interviews were conducted patients with CMP with varying histories of A/C use. Plan PCPs and contracted A/C providers took part in individual interviews. All participants were asked about their experiences managing chronic pain and experience with and/or attitudes about A/C treatment. Audio recordings were transcribed and thematically coded. A summarized version of the focus group/interview guides is included in the Additional file 1. We identified four themes around opioid use: (1) attitudes toward use of opioids to manage chronic pain; (2) the limited alternative options for chronic pain management; (3) the potential of A/C care as a tool to help manage pain; and (4) the complex system around chronic pain management. Despite widespread dissatisfaction with opioid medications for pain management, many practical barriers challenged access to other options. Most of the participants’ perceived A/C care as helpful for short term pain relief. We identified that problems with timing, expectations, and plan coverage limited A/C care potential for pain relief treatment. These results suggest that education about realistic expectations for chronic pain management and therapy options, as well as making A/C care more easily accessible, might lead to more satisfaction for patients and providers, and provide important input to policy makers. ClinicalTrials.gov NCT01345409, date of registration 28/4/2011 The online version of this article (doi:10.1186/s12875-016-0566-0) contains supplementary material, which is available to authorized users.