Understanding how primary care clinicians make sense of chronic pain

Laura G. Militello, Shilo Anders, Sarah M. Downs, Julie Diiulio, Elizabeth C. Danielson, Robert W. Hurley, Christopher A. Harle

Research output: Contribution to journalArticle

5 Scopus citations


Chronic pain leads to reduced quality of life for patients, and strains health systems worldwide. In the US and some other countries, the complexities of caring for chronic pain are exacerbated by individual and public health risks associated with commonly used opioid analgesics. To help understand and improve pain care, this article uses the data frame theory of sensemaking to explore how primary care clinicians in the US manage their patients with chronic noncancer pain. We conducted Critical Decision Method interviews with ten primary care clinicians about 30 individual patients with chronic pain. In these interviews, we identified several patients, social/environmental, and clinician factors that influence the frames clinicians use to assess their patients and determine a pain management plan. Findings suggest significant ambiguity and uncertainty in clinical pain management decision making. Therefore, interventions to improve pain care might focus on supporting sensemaking in the context of clinical evidence rather than attempting to provide clinicians with decontextualized and/or algorithm-based decision rules. Interventions might focus on delivering convenient and easily interpreted patient and social/environmental information in the context of clinical practice guidelines.

Original languageEnglish (US)
Pages (from-to)575-584
Number of pages10
JournalCognition, Technology and Work
Issue number4
StatePublished - Nov 1 2018


  • Chronic pain
  • Decision making
  • Health
  • Opioids
  • Primary care
  • Sensemaking

ASJC Scopus subject areas

  • Philosophy
  • Human-Computer Interaction
  • Computer Science Applications

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  • Cite this

    Militello, L. G., Anders, S., Downs, S. M., Diiulio, J., Danielson, E. C., Hurley, R. W., & Harle, C. A. (2018). Understanding how primary care clinicians make sense of chronic pain. Cognition, Technology and Work, 20(4), 575-584. https://doi.org/10.1007/s10111-018-0491-1