“They Don't Want Anything to Do with You”: Patient Views of Primary Care Management of Chronic Pain

Authors

  • Carole C. Upshur EdD,

    Corresponding author
    1. Department of Family Medicine and Community Health, University of Massachusetts Medical School, Worcester
      Carole C. Upshur, EdD, Department of Counseling, Graduate School of Education, University of Massachusetts, 100 Morrissey Blvd., Boston, MA 02125, USA; Tel: 774-443-7267; Fax: 774-441-6212; E-mail: carole.upshur@umassmed.edu.
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  • Gonzalo Bacigalupe EdD,

    1. Department of Counseling, University of Massachusetts, Boston, Massachusetts, USA
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  • Roger Luckmann MD, MPH

    1. Department of Family Medicine and Community Health, University of Massachusetts Medical School, Worcester
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  • Financial support: Agency for Health Care Research and Quality (1R03 HS013455).

  • Disclosures: None of the authors have any financial relationships or conflicts of interest with regard to this manuscript.

  • Prior Presentations: Parts of this manuscript were previously presented at the Annual Meeting of Academy Health, Boston MA, June, 2005 and the Annual Meeting of the Society for Behavioral Medicine, April 2005.

Carole C. Upshur, EdD, Department of Counseling, Graduate School of Education, University of Massachusetts, 100 Morrissey Blvd., Boston, MA 02125, USA; Tel: 774-443-7267; Fax: 774-441-6212; E-mail: carole.upshur@umassmed.edu.

Abstract

Objective.  Chronic pain is one of the most frequent complaints of patients in primary care, yet both patients and providers report low satisfaction with chronic pain care. This study was designed to explore the views held by a diverse sample of patients with chronic pain complaints about their care experiences to identify ways to improve care.

Design.  Qualitative analysis of 17 patient focus groups (size 3–7 participants). Groups used structured questions and were tape recorded, transcribed, and coded using qualitative software. Eleven groups were conducted in English, six groups in Spanish.

Patients.  Convenience sample of 72 adult patients (68% female, 44% Latino, mean age = 48.1 years) recruited from four diverse primary care practices in Central Massachusetts.

Results.  Across all 17 groups, and all gender, ethnicity, and age groups, most patients reported suboptimal interactions with their providers when seeking care for chronic pain. Subjects acknowledged feeling disrespected and distrusted, suspected of drug-seeking, and having their symptoms dismissed as trivial and/or not warranting medical care. Patients reported more satisfaction when they felt a provider listened to them, trusted them, was accessible to address pain concerns between visits, and used patient-centered approaches to establish goals and treatment plans. Patients also recommended some management techniques related to the chronic disease management model to improve pain care.

Conclusions.  Implementing patient-centered approaches in caring for individuals with chronic pain and using principles drawn from the chronic disease management model to improve care systems may improve both patient and provider satisfaction with chronic pain care.

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