Communicating about opioids for chronic pain: A qualitative study of patient attributions and the influence of the patient-physician relationship

Marianne Matthias, E. E. Krebs, A. A. Bergman, J. M. Coffing, Matthew Bair

Research output: Contribution to journalArticle

31 Citations (Scopus)

Abstract

Background Chronic pain poses numerous challenges for patients and providers, particularly when opioid treatment is discussed. Despite accounts of antagonistic patient-provider communication, little is known about how communication about opioids unfolds during clinic visits and, importantly, how the relationship history of a patient and physician shapes this communication. This study's objective was to advance understanding of communication about opioid treatment by recording primary care clinic visits and conducting in-depth interviews with patients to gain insight into the patient-provider relationship and its influence on clinical communication. Methods Forty patients with chronic pain were audio recorded during their primary care clinic appointments and then interviewed about their pain care and relationships with their providers. Ten patients were excluded from analysis because pain was not discussed during the clinic visit. Results Qualitative analysis revealed that patients responded in markedly different ways to similar physician treatment decisions about opioids. Some patients attributed limiting or denying opioids to physicians' distrust or lack of caring. Others attributed these limitations to acting out of genuine concern for patients' health. These attributions appeared to be shaped by features of the patient-physician relationship as described by patients. Results are discussed within the framework of attribution theory. Conclusions Understanding how patients and providers discuss opioid treatment is critical for optimal pain treatment. Physicians might be able to improve communication by re-framing treatment discussions about opioids around external factors, such as benefits and harms, and engaging in communication that fosters a strong therapeutic alliance and emphasizes concern for the patient.

Original languageEnglish
Pages (from-to)835-843
Number of pages9
JournalEuropean Journal of Pain
Volume18
Issue number6
DOIs
StatePublished - 2014

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Physician-Patient Relations
Chronic Pain
Opioid Analgesics
Communication
Ambulatory Care
Physicians
Pain
Therapeutics
Primary Health Care
Acting Out

ASJC Scopus subject areas

  • Anesthesiology and Pain Medicine
  • Medicine(all)

Cite this

Communicating about opioids for chronic pain : A qualitative study of patient attributions and the influence of the patient-physician relationship. / Matthias, Marianne; Krebs, E. E.; Bergman, A. A.; Coffing, J. M.; Bair, Matthew.

In: European Journal of Pain, Vol. 18, No. 6, 2014, p. 835-843.

Research output: Contribution to journalArticle

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