The Patient-Provider Relationship in Chronic Pain Care: Providers' Perspectives

Background. Pain is the most commonly reported symptom in primary care and is a leading cause of disability. Primary care providers (PCPs) face numerous challenges in caring for patients with chronic pain including communication and relational difficulties. Objective. The objective of the study was to elicit providers' perspectives on their experiences in caring for patients with chronic pain. Design. The design used was a qualitative study using open-ended, in-depth interviews. Participants. Twenty providers (10 men, 10 women) from five different clinics were interviewed at the Roudebush Veterans Affairs Medical Center. Results. Three broad themes emerged from the analysis: 1) providers emphasized the importance of the patient-provider relationship, asserting that productive relationships with patients are essential for good pain care; 2) providers detailed difficulties they encounter when caring for patients with chronic pain, including feeling pressured to treat with opioids, believability of patients' reports of pain, worries about secondary gain/diversion, and abusive or difficult patients; and 3) providers described the emotional toll they sometimes felt with chronic pain care, including feeling frustrated, ungratified, and guilty. Findings. Findings were interpreted within a model of patient-centered care. Conclusions. The clinical implications of these findings are two-fold. First, PCPs' needs cannot be ignored when considering pain care. PCPs need support, both instrumental and emotional, as they care for patients with chronic pain. Second, improving PCPs' patient-centered communication skills including demonstrating empathy and encouraging shared decision-making holds promise for alleviating some of the strain and burden reported by providers, ultimately leading to improved patient care.