Beyond pain & meds: Paired interviews of chronic pain patients on chronic opioid therapy (COT) and their physicians Angela Yang, AMSII

How do long-term narcotics for chronic pain patients affect the doctor- patient relationship?

Collect narratives: Interview patients and physicians pairs Analyze (ongoing) : identify themes, patterns, areas of convergence and mismatch Identify/explore barriers to good communication and compassionate care (ongoing) Brainstorm: How can the doctor be a more effective communicator and advocate for chronic pain patients on COT? How do we bridge these gaps? What resources need to be developed for both patients and physicians ? Interventions/solutions Overview

How? Patients recruited through their physicians at the Family Care Center (FCC) of Memorial Hospital Where? 11 home visits, 10 at FCC Who? 21 chronic non malignant pain patients 16 physicians (of all levels of training) What? The In-depth Interview: I.Pain II.Pain meds III. Relationship with Doctor Questionnaires : SF- 12, Graded Chronic Pain Scale 2.0, Prescribed Opioid Difficulties Scale, and a pictorial depiction of pain. Collecting narratives Patient Demographics Age Sex Male8 Female13 Employment/disability SSID15 Employed4 Unemployed2 Marital Status Single11 Married3 Divorced6 Widowed1 Total21

Initial results Patients: Suffering from chronic pain Role of opioid therapy for pain relief Reliance on physicians for pain management Physicians Many challenges of treating chronic pain patients on COT Subjectivity of pain Problems such as diversion and dishonesty Lack of effective therapies for pain Concerns of harming patients by enabling an addiction ***Interviews are being examined for important themes, patterns, and major areas of convergence, and divergence/mismatch in the following groups: patients, physicians, and patient-physician pairs.

Pain confines both patients and physicians immeasurably Patients and physicians share a strong desire to improve patient functionality and to find pain relief but long-term goals and outcomes are often unclear or unaddressed Divergent patterns on the consequences, utility, and goals of COT underlie its impact on the doctor-patient relationship. My current focus: the dialogue and tensions that derive from pain meds and perceptions about addiction Unmet goals/weaknesses of the project thus far I’m learning that …

What’s to come: ideas for healing interactions Medical education: students visiting chronic pain patients Potential interventions:  chronic pain patient support groups  module for physicians  handout for chronic pain patients on COT  chronic pain patient advocate/counselor Art/prose/poetry pieces that give both patients and doctors a voice

Much gratitude to: Jeffrey Borkan, MD, PhD, Department of Family Medicine, AMS Irene Reis, Administrative Assistant, Dept. of Family Medicine Dr. Schraeder, Physician as Communicator SC Memorial Hospital FCC: residents, attendings, & staff Patients Friends- Green Tea analysis team And RI AHEC for support to make this research journey possible!

Thank you!!! Questions? Suggestions?