Barriers and facilitators to use of non-pharmacological treatments in chronic pain

William C Becker,Alicia A Heapy,Liana Fraenkel,Lindsey Dorflinger,Leila Islam,Sara N Edmond

doi:10.1186/s12875-017-0608-2

Abstract

BackgroundConsensus guidelines recommend multi-modal chronic pain treatment with increased uptake of non-pharmacological pain treatment modalities (NPMs). We aimed to identify the barriers and facilitators to uptake of evidence-based NPMs from the perspectives of patients, nurses and primary care providers (PCPs).MethodsWe convened eight separate groups and engaged each in a Nominal Group Technique (NGT) in which participants: (1) created an individual list of barriers (and, in a subsequent round, facilitators) to uptake of NPMs; (2) compiled a group list from the individual lists; and (3) anonymously voted on the top three most important barriers and facilitators. In a separate process, research staff reviewed each group’s responses and categorized them based on staff consensus.ResultsOverall, 26 patients (14 women) with chronic pain participated; their mean age was 55. Overall, 14 nurses and 12 PCPs participated. Seven healthcare professionals were men and 19 were women; the mean age was 45. We categorized barriers and facilitators as related to access, patient-provider interaction, treatment beliefs and support. Top-ranked patient-reported barriers included high cost, transportation problems and low motivation, while top-ranked facilitators included availability of a wider array of NPMs and a team-based approach that included follow-up. Top-ranked provider-reported barriers included inability to promote NPMs once opioid therapy was started and patient skepticism about efficacy of NPMs, while top-ranked facilitators included promotion of a facility-wide treatment philosophy and increased patient knowledge about risks and benefits of NPMs.ConclusionsIn a multi-stakeholder qualitative study using NGT, we found a diverse array of potentially modifiable barriers and facilitators to NPM uptake that may serve as important targets for program development.

Highlights

Consensus guidelines recommend multi-modal chronic pain treatment with increased uptake of nonpharmacological pain treatment modalities (NPMs)
In a multi-stakeholder qualitative study using Nominal Group Technique (NGT), we found a diverse array of potentially modifiable barriers and facilitators to NPM uptake that may serve as important targets for program development
Because of the widespread prevalence of chronic pain and the major impact it has on quality of life, integrated health systems such as Kaiser Permanente and the Veterans Health Administration (VHA) have sought to make multi-modal pain care widely available [19], even establishing virtual treatment networks relying on telehealth to deliver some NPMs to remote areas [20]

Summary

Introduction

Consensus guidelines recommend multi-modal chronic pain treatment with increased uptake of nonpharmacological pain treatment modalities (NPMs). Because of the widespread prevalence of chronic pain and the major impact it has on quality of life, integrated health systems such as Kaiser Permanente and the Veterans Health Administration (VHA) have sought to make multi-modal pain care widely available [19], even establishing virtual treatment networks relying on telehealth to deliver some NPMs to remote areas [20] Despite these efforts, at some centers, NPM utilization remains relatively low [21]. The Institute of Medicine, and more recently the Department of Health and Human Services, called for a comprehensive examination of barriers “to help close the gap between empirical evidence regarding the efficacy of pain treatments and current practice.” [1] In an effort to identify such barriers and facilitators to inform the design of effective strategies for health systems to increase utilization of NPMs, we studied the perspectives of two stakeholder groups: patients with chronic pain and healthcare professionals (nurses and primary care providers (PCPs)). While other studies have examined qualitative factors related to pain management from patient [22, 23] and provider perspectives [24,25,26], our study is novel in its focus on non-pharmacological treatments, examining patient and provider perspectives simultaneously, our use of the nominal group technique (described below), and our inclusion of nurses, whose role in delivering multimodal, team-based pain care is essential

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