Identifying Communicative Factors Affecting Opioid Management for Chronic Pain

描述（由申请人提供）：近几十年来，阿片类药物在慢性非癌性疼痛（CNCP）治疗中的使用和误用急剧增加。我们的主要假设是，患者与医生之间的开放式沟通，包括讨论阿片类药物是否是患者的最佳治疗方法，阿片类药物的风险和益处以及阿片类药物监测策略，将减少阿片类药物滥用的可能性。然而，慢性疼痛患者和他们的医生之间的沟通问题破坏了这些努力。鉴于与阿片类药物相关的风险，无论是在副作用还是滥用方面，患者和医生就阿片类药物的风险和益处进行有效沟通和决策至关重要。我们的长期目标是为医生开发和测试量身定制的干预措施，以改善他们与患者关于阿片类药物治疗的沟通。这项初步研究的目的是确定CNCP患者及其医生用于管理阿片类药物的沟通策略。我们将进行一项纵向观察性研究，在该研究中，我们将在3次初级保健诊所访视期间对36例已为CNCP开具阿片类药物的患者进行录音。我们将对记录进行编码，用于探索和验证患者的担忧，用于疼痛评估的深度，以及用于共享决策-以患者为中心的关键沟通变量。我们还将对患者进行深入的定性访谈和刺激回忆，以确定和描述CNCP患者认为对有效的疼痛和阿片类药物管理很重要的医生沟通的crucia质量。用于治疗慢性疼痛的阿片类药物可能导致误用，严重的医疗并发症，甚至死亡。在2009-2010年，超过500万美国人报告在过去一个月内使用阿片类药物用于非医疗目的。2008年，阿片类镇痛药导致近15,000人死亡，比海洛因和可卡因的死亡人数还要多。这是一个公共优先事项，发现成功的阿片类药物管理战略CNCP和转化为实践这些战略。

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.