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.