The family physician experience of treating chronic pain patients whose pain has complex etiology: A qualitative study

The goal of this project was to understand the family physician experience of working with chronic pain patients whose pain has complex etiology. The long-range research purpose was to discover the components of the physician-chronic pain patient relationship that could serve as the basis of future research projects predicting effective clinical interventions. These more successful treatments could be the basis of future physician training courses.; This qualitative research project was conducted by interviewing 11 physicians from 8 states. The interview guide directed physicians to describe problematic cases compared to more successful cases. Physicians discussed diagnoses, treatments, personal expertise, professional issues, patient relationship concerns, goals and expectations, physician and patient reactions, psychosocial factors, and referrals.; The only beneficial treatments mentioned by all physicians were physical therapy, anti-depressants, and counseling. Four main themes were the most frequently discussed: (a) the significance of the multifactorial nature of chronic pain, (b) the importance of understanding opioids and addiction issues in the treatment of chronic pain, (c) the creation of an effective working partnership between physician and patient, and (d) the significance of helping patients refocus their goals from pain elimination to daily functioning and adaptation.; The results of this study were compared to previous findings reported in the literature and confirmed the importance of the following themes: (a) consideration of psychosocial factors and a multidisciplinary approach when working with chronic pain patients; (b) maintenance of an effective physician-patient relationship where the physician is sensitive to the patient perspective; (c) understanding the foundations of relationship problems such as patient psychiatric co-morbidity; and (d) physician awareness of, and ability to cope with, his or her own negative reactions to certain chronic pain situations.; Several themes were stressed in the literature but not in the research: (a) the importance of the physicians' ability to analyze their own reactions to chronic pain patient experiences, and (b) the significance of the physicians' willingness to use support systems when coping with these problematic personal reactions. Themes that were stressed in the research but not in the literature were: (a) the problematic nature of opioid usage in chronic pain situations, (b) the contrasting goals of pain elimination versus adaptation and functioning, and (c) the patient tendency to deny psychosocial aspects of chronic pain. Ideas for future research projects are outlined. For example, valuable studies would determine methods by which to educate (a) physicians about the importance of self-analysis, and (b) chronic pain patients about the significance of the psychosocial components of chronic pain.