Opioids, Chronic Pain, and Addiction in Primary Care
Opioids, Chronic Pain, and Addiction in Primary Care
复制标题
DOI：
10.1016/j.jpain.2010.04.002
复制
发表时间：
2010-12-01
期刊：
影响因子：
4
通讯作者：
Fiellin, David A.
中科院分区：
文献类型：
--
作者：
Barry, Declan T.;Irwin, Kevin S.;Fiellin, David A.
研究在很大程度上忽略了对医生对慢性非癌性疼痛患者提供护理的态度进行系统检查。本研究的目的是确定办公室医疗服务提供者对慢性非癌性疼痛患者进行阿片类药物治疗的障碍和促进因素。我们采用个人访谈和小组访谈的定性研究设计。参与者是新英格兰的 23 名办公室医生。采访由多学科团队使用持续比较方法进行录音、转录和系统编码。医生障碍包括缺乏客观或客观的认知。疼痛的生理测量、缺乏治疗慢性疼痛和共存疾病（包括成瘾）的专业知识 对疼痛管理缺乏兴趣、患者异常行为和医生对处方阿片类镇痛药的态度 医生协助者包括促进患者护理的连续性和阿片类药物协议的使用 医生对患者相关障碍的看法包括医生对患者疼痛报告缺乏反应、对阿片类镇痛药的消极态度、对阿片类镇痛药的担忧感知的后勤障碍包括缺乏适当的疼痛管理和成瘾转诊选项、有关诊断检查的信息有限、疼痛管理服务的保险覆盖范围有限、对医生的辅助支持有限和时间不足。解决疼痛治疗的这些障碍对于改善疼痛管理服务提供至关重要。观点本文表明，治疗慢性非癌症疼痛患者的感知障碍在办公室医生中很常见。在医生培训和现有办公室计划中解决这些障碍可能会使非癌症慢性疼痛患者及其患者受益。医疗服务提供者 (c) 2010 年，美国疼痛协会
Research has largely ignored the systematic examination of physicians' attitudes towards providing care for patients with chronic noncancer pain The objective of this study was to identify barriers and facilitators to opioid treatment of chronic noncancer pain patients by office-based medical providers We used a qualitative study design using individual and group interviews Participants were 23 office-based physicians in New England Interviews were audiotaped, transcribed, and systematically coded by a multidisciplinary team using the constant comparative method Physician barriers included absence of objective or physiological measures of pain, lack of expertise in the treatment of chronic pain and coexisting disorders including addiction lack of interest in pain management, patients aberrant behaviors and physicians attitudes toward prescribing opioid analgesics Physician facilitators included promoting continuity of patient care and the use of opioid agreements Physicians' perceptions of patient-related barriers included lack of physician responsiveness to patients' pain reports, negative attitudes toward opioid analgesics, concerns about cost, and patients' low motivation for pain treatment Perceived logistical barriers included lack of appropriate pain management and addiction referral options, limited information regarding diagnostic workup, limited insurance coverage for pain management services limited ancillary support for physicians and insufficient time Addressing these barriers to pain treatment will be crucial to improving pain management service deliveryPerspective This article demonstrates that perceived barriers to treating patients with chronic noncancer pain are common among office-based physicians Addressing these barriers in physician training and in existing office-based programs might benefit both noncancer chronic pain patients and their medical providers (c) 2010 by the American Pain Society