Identifying Communicative Factors Affecting Opioid Management for Chronic Pain

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DESCRIPTION (provided by applicant): Opioid use and misuse in the treatment of chronic non-cancer pain (CNCP) has increased dramatically in recent decades. Our primary hypothesis is that open communication between patients and their physicians that includes discussions about whether opioids are the best treatment for a patient, the risks and benefits of opioids, and opioid monitoring strategies will reduce the potential for opioid misuse. However, well-documented communication problems between patients with chronic pain and their physicians undermine these efforts. Given the risks associated with opioids, both in terms of side effects and misuse, it is critical for patients and physicians to engage in effective communication and decision-making about the risks and benefits of opioids. Our long-term goal is to develop and test tailored interventions for physicians to improve their communication with patients about opioid treatment. The purpose of this pilot study is to identify communication strategies patients with CNCP and their physicians use to manage opioids. We will conduct a longitudinal observational study in which we will audio-record 36 patients, who have been prescribed opioids for CNCP, over the course of 3 primary care clinic visits. We will code the recordings for exploring and validating patient concerns, for the depth of pain assessment, and for shared decision-making - key patient-centered communication variables. We will also conduct in-depth qualitative interviews and stimulated recall sessions with patients to identify and describe crucia qualities of physician communication that patients with CNCP believe are important for effective pain and opioid management. Relevance Opioids prescribed to manage chronic pain can lead to misuse, serious medical complications, and even death. In 2009-2010, over 5 million Americans reported using opioids for non-medical purposes in the past month. In 2008, opioid analgesics were involved in nearly 15,000 deaths-more than from heroin and cocaine. It is a public priority to discover successful opioid management strategies for CNCP and to translate these strategies into practice.