Barriers to managing chronic pain: perspectives of Appalachian providers

Abstract

Objective Chronic pain is an important cause of morbidity among adults worldwide. Its management presents a greater challenge in the unique demographic of Appalachia. “Physician reluctance to prescribe opioids” has been identified as a major barrier to effective management of chronic pain nationally. The aim of this study was to determine whether prescribers in Appalachian Ohio encountered similar barriers as prescribers elsewhere. Methods A 29-item questionnaire was distributed to all 1719 physicians practicing in 29 counties in Ohio designated as “Appalachia.” The questionnaire evaluated demographics, assessed aspects of pain management, and asked participants to rank a list of 11 perceived barriers to effective chronic pain management. Results The overall survey return rate was 25.9%. The average respondent was male, 51 years old, with 20 years of experience practicing medicine, spending 86% of the working week with patients. Most participants (72.5%) reported being involved with chronic pain management “several times each week” or more. Of the potential barriers, those identified as important were (1) patient reluctance to make lifestyle or behavioral changes, (2) inadequate access to pain specialists, (3) inadequate access to health care because of financial burden, (4) lack of an objective measurement of pain, and (5) physician reluctance to prescribe opioids. Conclusion Prescribers in Appalachian Ohio identified issues of patient behaviors and health care accessibility as important barriers, in addition to top barriers previously described in the literature. Further research must be done to determine whether these results are unique to Appalachian populations.