Provider and Patient Perspectives on Opioids and Alternative Treatments for Managing Chronic Pain:
A Qualitative Study

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SOURCE:   BMC Fam Pract. 2017 (Mar 24); 17 (1): 164

Lauren S. Penney, Cheryl Ritenbaugh, Lynn L. DeBar,
Charles Elder and Richard A. Deyo

South Texas Veterans Health Care System,
7400 Merton Minter Blvd,
San Antonio, TX, 78229, USA

BACKGROUND:   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.

METHODS:   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 (medical) 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.

RESULTS:   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 acupuncture and chiropractic (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.

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CONCLUSIONS:   These results suggest that education about realistic expectations for chronic pain management and therapy options, as well as making acupuncture and chiropractic (A/C) care more easily accessible, might lead to more satisfaction for patients and providers, and provide important input to policy makers.

TRIAL REGISTRATION: NCT01345409, date of registration 28/4/2011.

KEYWORDS:   Acupuncture; Chiropractic; Chronic pain; Complementary medicine; Opioids; Primary care

From the FULL TEXT Article


Chronic pain conditions are pervasive public health issues that exact a staggering human and economic toll. Indeed, persistent pain affects an estimated 19% of adults in the U.S. [1] and results in $560 billion in direct medical treatment costs and lost productivity. This is especially troubling as these conditions disproportionately affect vulnerable populations [2]. The past decades have seen a dramatic escalation in the use of prescription opioids for the treatment of chronic non-cancer pain [3]. The period spanning the 1980’s through the early 2000’s has been widely described as an opioid epidemic [4] driven by the rising number of chronic non-cancer pain sufferers, liberalization of laws governing the use of opioids in pain treatment, aggressive pharmaceutical marketing, an acceptance of opioids as standard treatment of chronic pain, and mounting pressure on physicians to avoid undertreating pain [3, 5–7].

Along with the rise in opioid prescribing for pain treatment [8] has come an increasing awareness of adverse outcomes, including addiction, transitioning to illegal drugs, and death (e.g., [9–14]) as well as concern about the limitations and efficacy of treatment with opioids in chronic pain management [7, 15–17]. In response, recent guidelines have been proposed for mitigating the risk of adverse outcomes [18], but evidence of effectiveness of many such guidelines is lacking [19]. Further, the clinical milieu has fostered a shift toward treatment that focuses on increasing patients’ functioning rather than on pain reduction [20].

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