Chronic Pain Management Experiences in Immigrant Populations: A Qualitative Study

Individual perceptions form the basis of many health research reports related to access, utilization, continuity, and quality. Many health care providers are not well equipped for designing studies or collecting data with immigrant populations. In this article, the authors examine issues in data collection on topics related to perceptions of quality of prenatal care among immigrant Latino populations. The conceptual model is Donabedian's framework for quality. Two instruments--a qualitative interview with photographs representing components of quality and a questionnaire--were used for data collection. Examples of narrative responses given by women in response to the photo-narrative prompts are presented and compared to shorter survey responses. The authors emphasize the importance of designing research instruments that reflect the perceptions of the research subjects rather than simply those of the investigators.

Evaluating chronic pain interventions in recent refugees and immigrant populations: A systematic review

Beyond the needle: expanding the role of anesthesiologists in the management of chronic non-malignant pain.

Immigrant populations are moving to new destinations across the country and no longer settling predominantly in established immigrant destinations, causing stress on local governments. Local governments increasingly rely on nonprofit organizations to provide services to immigrant and refugee populations. To contribute to research in this area, this dissertation examines ways nonprofit organizations work with immigrant populations. In Chapter 1, I use qualitative interview data to examine how food bank staff connect immigrant groups to public services. In Chapters 2 and 3, I focus on immigrant nonprofit organizations. I use census and immigrant nonprofit data and regression analysis to examine where immigrant nonprofits may be located. Findings from this dissertation highlight the importance of the local context when initiating strategies to engage with immigrant populations and when examining factors associated with the presence of an immigrant nonprofit.

BackgroundCurrent gold standard chronic pain management applies a biopsychosocial lens to clinical care, integrating medication, psychosocial support, and physical reconditioning to promote sustained treatment success, increase quality of life, and control symptoms. However, only 40% of patients with chronic pain report adequate pain management. Unfortunately, evidence describing implemented treatment pathways or models of care (MoCs) that consistently use this holistic approach is lacking.ObjectiveThe aim of this study is to identify the barriers and facilitators to access and engagement in existing MoCs for chronic pain, explore aspects of the delivery of care that can be improved, and develop an improved MoC for pain clinics in New South Wales by directly liaising with people with chronic pain and their families.MethodsA 2-phase qualitative study will be conducted using semistructured focus groups. Both phases will follow the same structure, so patients, carers, and clinicians will independently provide input into the proposed MoC, which will then be summarized and integrated by the research team. Participants will be encouraged to interact and speak freely across three core domains: (1) experience of chronic pain management, (2) barriers and facilitators to delivering/accessing a gold standard MoC, and (3) key improvement points to existing models. Each focus group will last 90 minutes and be audio-recorded and transcribed verbatim for qualitative analysis. The focus groups in phase one will generate initial recommendations for primary changes to the existing MoC, and these will then be integrated and presented for evaluation, feasibility, and acceptability by stakeholder groups during phase two.ResultsData collection commenced in September 2023 and is expected to end by September 2025. As of February 2024, we have completed the focus group with clinicians (n=12) and patients (n=7) in phase one. Data have not been analyzed formally and will be reported in a future publication.ConclusionsThrough the exploration of key stakeholders’ perspectives of the barriers preventing access and the delivery of care in the current MoC for chronic pain, we aim to co-design an appropriate, feasible, and acceptable pathway to be implemented in pain services in the future.International Registered Report Identifier (IRRID)DERR1-10.2196/59126

Purpose: To explore and obtain increased knowledge about (i) strategies and treatments used by individuals with neuropathic pain following spinal cord injury (SCI) for handling long-term pain, and (ii) their experience, needs and expectations of SCI neuropathic pain management. Methods: Qualitative methods with an emergent research design were used. Eighteen informants who suffered from long-term SCI neuropathic pain participated. Data were collected with diaries and thematized research interviews. Content analysis and constant comparison according to grounded theory were used for the analyses. Results: A model with four categories emerged: “Pain is my main problem” explained the impact of pain in the informants’ everyday life; “Drugs – the health care solution” described the informants’ experience of pain management; “The gap in my meeting with health care” described the discrepancy between what the informants wanted and what health care could offer. “But…this works for me” described treatments and strategies, which the informants found helpful for pain control and pain relief. Conclusion: Neuropathic pain, one of the major problems following SCI, is difficult to treat successfully. To improve treatment outcome, health care needs to listen to, respond to and respect the patient’s knowledge, experience and wishes. Future research needs to address treatments that patients find effective.Implications for RehabilitationPatients’ experiences, knowledge and preferences need to be taken into account when designing pain management.Complementary treatments (non-pharmacological) ought to be an important part of successful neuropathic pain management.

Objective: Chronic musculoskeletal pain is a complex condition to manage with widespread consequences including physical disability, psychosocial effects and increased use of healthcare. Previous research has found patients’ experiences within health care can be influenced by factors such as expectations, therapist characteristics and treatment process. This study used patient interviews to identify the key factors that influence individuals’ experiences in the management of chronic pain.Design: Qualitative study using semi-structured interviews in either a home or hospital setting.Methods: Semi-structured interviews were conducted on eight participants attending hospital-based pain management. Participants were asked about their experiences of pain management and living with a chronic pain condition. Interviews were transcribed and analysed thematically.Results: Three main themes were identified; impact of their condition on daily life, clinical interactions and the pain management process. Understanding the condition was a key factor for the patients, in particular, explanation by the clinician. The temporality of their pain meant timing of appointments was critical. Patients reported factors such as family days and follow-up sessions would improve their treatment experience.Conclusions: This study highlighted important factors for healthcare professionals and patients in the management of chronic pain. Participants indicated a desire to understand their condition and learn strategies for self-management to allow them to cope better. As patients found benefit from being involved in the management process, discussions around the options for treatment may enhance management and rehabilitation. It is important we continue to research factors important to individuals with musculoskeletal pain to find an effective, evidence-based framework for understanding and managing this condition.Implications for rehabilitationThis study highlights the importance to patients of being given information to help them understand their pain condition and to learn strategies for self-management to cope better.Where information was not provided and inadequate time allowed for questioning and discussion, patients tended to desire more frequent access to the care services. More effective communication may result in reduced demand and more efficient management.Patients suggested that ongoing peer support may offer an alternative to clinician-led services.

While pain may persist for patients who undergo pelvic exenteration for treatment of locally recurrent rectal cancer, studies exploring patient experience of postoperative pain and its management remain limited. This study aimed to explore patient experiences of postoperative chronic pain and management after pelvic exenteration. Qualitative cohort study of patients who have undergone pelvic exenteration for locally recurrent rectal cancer. The study was conducted through one-to-one semi-structured telephone interviews. Seventeen patients with locally recurrent rectal cancer who underwent pelvic exenteration between January 2018 and December 2020 were included. Semi-structured interviews explored participants' experiences of pain, including its impact on life and management strategies, at 6 and 12 months after exenteration. Interview transcripts were analyzed by two researchers using inductive thematic analysis. Participant experiences of pain after exenteration are reflected by three identified themes: 1) adapting to long-term consequences of pelvic exenteration, including pain; 2) reluctance to take pain medications; and 3) engaging a multidisciplinary care team is essential to post-pelvic exenteration chronic pain management. Several participants reported ongoing intermittent pain after surgery that significantly affected various aspects of their lives. This prompted participants to adapt their lifestyles and explore alternative pain relief methods because some were hesitant to rely on analgesics. The small sample size from a single center, whereby all patients underwent curative pelvic exenteration for lower recurrent rectal cancer, with none undergoing the procedure for palliation, limits the generalizability of the results of this study. Although chronic pain after pelvic exenteration for locally recurrent rectal cancer interferes with patient's postoperative quality of life, analgesia use was influenced by pain habituation and fear of dependence on pain medications. Our findings emphasize the need to further investigate a multidisciplinary approach, including nonpharmacological methods, for optimization of pain outcomes after pelvic exenteration. See Video Abstract . ANTECEDENTES:Aunque el dolor puede persistir en los pacientes que se someten a una exanteración pélvica para el tratamiento del cáncer rectal localmente recurrente, los estudios que exploran la experiencia del paciente con el dolor post operatorio y su manejo siguen siendo limitados.OBJETIVO:Este estudio tuvo como objetivo explorar las experiencias de los pacientes con el dolor crónico post operatorio y el manejo después de la exanteración pélvica.DISEÑO:Estudio de cohorte cualitativo de pacientes que se han sometido a una exanteración pélvica para el cáncer rectal localmente recurrente.ESCENARIO:El estudio se realizó a través de entrevistas telefónicas semiestructuradas individuales.PACIENTES:Se incluyeron diecisiete pacientes con cáncer rectal localmente recurrente que se sometieron a una exanteración pélvica entre enero de 2018 y diciembre de 2020.PRINCIPALES MEDIDAS DE RESULTADOS:Las entrevistas semiestructuradas exploraron las experiencias de los participantes con el dolor, incluido su impacto en la vida y las estrategias de manejo a los seis y doce meses después de la exanteración. Las transcripciones de las entrevistas fueron analizadas por dos investigadores utilizando un análisis temático inductivo.RESULTADOS:Las experiencias de dolor de los participantes después de la exanteración se reflejan en tres temas identificados: 1) adaptación a las consecuencias a largo plazo de la exanteración pélvica, incluido el dolor; 2) renuencia a tomar analgésicos; 3) la participación de un equipo de atención multidisciplinario es esencial para el manejo del dolor crónico posterior a la exanteración pélvica. Varios participantes informaron dolor intermitente continuo después de la cirugía que afectó significativamente varios aspectos de sus vidas. Esto impulsó a los participantes a adaptar su estilo de vida y explorar métodos alternativos de alivio del dolor, ya que algunos dudaban en confiar en los analgésicos.LIMITACIONES:El pequeño tamaño de la muestra de un solo centro en el que todos los pacientes se sometieron a una exanteración pélvica curativa para el cáncer rectal recurrente inferior y ninguno se sometió al procedimiento para paliar limita la generalización de los resultados de este estudio.CONCLUSIONES:Si bien el dolor crónico posterior a la exanteración pélvica para el cáncer rectal recurrente local interfiere con la calidad de vida post operatoria del paciente, el uso de analgésicos se vio influenciado por la habituación al dolor y el miedo a la dependencia de los analgésicos. Nuestros hallazgos enfatizan la necesidad de investigar aún más un enfoque multidisciplinario, que incluya métodos no farmacológicos, para optimizar los resultados del dolor después de la exanteración pélvica. (Traducción-Dr. Mauricio Santamaria ).

Chronic non-cancer pain is a highly prevalent health issue with personal and societal consequences. Patients suffering from chronic non-cancer pain are mainly cared for by primary care physicians, but research shows that the latter perceive treating chronic pain as difficult. This qualitative descriptive study aimed to explore how primary care physicians in Switzerland manage patients with chronic non-cancer pain and what factors influence patient management. Data were collected through semi-structured interviews amongst primary care physicians in the German speaking part of Switzerland. A thematic analysis of the interviews allowed to identify four main themes: Investigation of chronic pain; patient-provider relationship; patient characteristics, and medical recommendations. These themes were closely interconnected and influenced each other. Physicians not only enquired about the origin of pain but also about the patients' beliefs and expectations towards it. They stressed the role of communication in fostering a good patient-physician relationship and to help patients cope with their pain. In addition to purely medical considerations, the psychological, social and economic situation of their patients and their possible impacts on the management of chronic non-cancer pain played a crucial role when recommending a treatment. This study highlighted the complexity of chronic pain management, which entails that primary care physicians need to figure out a unique strategy for each patient. By integrating patients' values and beliefs, as well as socioeconomic aspects, primary care physicians are in a position to take the lead in chronic non-cancer pain management. However, considering the burden of this disease, more continuous medical education on chronic pain is needed for primary care physicians, especially to better take into account the social determinants of pain.

Background Chronic pain is a prevalent and debilitating condition for many people. Globally it is the greatest contributor to years lived with disability. Management often includes pharmacotherapy and pharmacists are therefore well placed to contribute to chronic pain management. Objective To explore chronic pain management in community-dwelling analgesic users with poorly controlled pain and investigate potential barriers to adequate pain management. Setting Regional Victoria, Australia. Method A descriptive qualitative approach was used. People who had been prescribed an analgesic for at least 6months and reported an average pain score over the last week of 4 or more out of 10 were interviewed about their pain management. Interviews followed a semi-structured interview guide. Thematic analysis of the data was undertaken followed by participant validation of the key themes. Main outcome measure Experience of chronic pain management. Results Three female and eight male people, aged between 34 and 77years were interviewed. The study demonstrated that there was a diverse range of issues relating to chronic pain management that fitted into seven major themes: impact of pain on life, invisibility of pain, issues associated with healthcare professionals, general medication issues, attitude towards taking analgesics, medication adherence, and attitude towards other treatment options. Chronic pain had dramatically altered the lives of all participants and their families as they came to accept and learn to live with the pain they experienced. The main barrier to adequate pain management was the invisibility of pain, which resulted in health professionals undertreating the pain reported by participants. Participants desire to take as few analgesics as possible, the reluctance of GPs to prescribe opioids and healthcare professionals focus on misuse also contributed to poor pain management. Conclusion Participants were able to accept high levels of pain while minimizing analgesic use. The two main barriers to adequate pain management were the invisibility of pain, which resulted in health professionals not treating the pain reported by the participant and the perception of participants that analgesics should not need to be taken regularly in adequate doses for the rest of their lives.

The experience and understanding of pain management in recently discharged adult trauma patients: A qualitative study

We explore the attitudes and experience of urology residents toward acute and chronic pain management during their training. A convenience sample of Canadian Urology chief residents were invited to complete an anonymous questionnaire involving both open and closed-ended questions using a 5-point Likert scale. Descriptive and quantitative statistics were used to analyze the attitudes toward pain management, including their experience and training issues. The response rate was 97%. Most residents agreed or strongly agreed that more formal training in acute pain (77% agreement, mean 4.03 ± 0.98 SD) and chronic pain (68%, 3.97 ± 0.95) management would be valuable in urology residency with only 1 respondent disagreeing that training should be mandatory. There was a significant difference of training experience in chronic versus acute pain management, with only 13% agreement (2.99 ± 0.67) that their training in chronic pain was adequate. Most residents agreed (74%, 3.84 ± 1.00) that most of their training in pain management came from their senior residents or fellows. Many of the residents (65%, 3.61 ± 0.84) felt that they could manage their patients' acute pain issues independently, even in the absence of an acute pain service, although apparent knowledge of opioids was poor. The results of this survey suggest that urology residents attain their knowledge of pain management experientially with what may be insufficient formal training, particularly in chronic pain. These observations are limited by the relatively small number of respondents and by the nature of a cross-sectional, self-reported survey; however, they would appear to underscore a need to redouble efforts in residency education.

JessicaVasquez‐Tokos, Marriage Vows and Racial Choices, New York: Russell Sage Foundation, 2017. xi + 272 p. $26.00.

Physician-pharmacist collaboration on chronic non-cancer pain management during the opioid crisis: A qualitative interview study.

BackgroundChronic pain management in older adults can be challenging for primary care clinicians due to comorbidities, side effects, and complicated guideline recommendations. Clinical decision support systems (CDSSs) may improve care by integrating guideline-based recommendations, synthesizing relevant patient data, and facilitating shared decision-making. I-COPE (Improving Chicago Older Adult Opioid and Pain Management through Patient-centered Clinical Decision Support and Project ECHO) is an electronic health record–based CDSS designed to gather patient-reported data and support primary care clinicians in managing chronic pain, opioid use, and opioid use disorder in older adults.ObjectiveThis study examined clinicians’ views on challenges in managing chronic pain and their opinions on I-COPE.MethodsWe conducted semi-structured interviews with 18 clinicians (16 physicians and 2 advanced practice nurses) from 2 University of Chicago Medicine primary care clinics (internal medicine and geriatrics) piloting the I-COPE CDSSs in 2021. The interview guide was informed by the Consolidated Framework for Implementation Research and explored current practices in chronic pain management, challenges, and feedback on I-COPE tools.ResultsOf the 18 participants, 12 (67%) identified as female, 13 (72%) as White, and 9 (50%) had practiced for 10 years or less. Participants stressed the importance of a comprehensive, patient-centered approach to chronic pain management and prioritized multimodal and nonpharmacological treatments. Major barriers to effective chronic pain management were comorbidities, limited visit time, insurance coverage restrictions, and opioid misuse concerns. Most clinicians found the CDSSs beneficial for standardizing multimodal care discussions, enhancing visit efficiency, eliciting patient goals, and facilitating shared decision-making conversations. Clinicians raised concerns about the complexity of the intervention, anticipated issues with clinic workflow, and desired more adaptability. The primary care clinicians in this study demonstrated strong alignment with current pain management guidelines, prioritizing patient-centered pain management using multimodal treatments. They identified I-COPE as a promising tool to reinforce evidence-based practices, increase efficiency, and strengthen patient-clinician communication. However, implementation challenges—particularly around accessibility for older adults, workflow integration, and tool complexity—highlight the need for further refinement and support.ConclusionsI-COPE offers a promising approach to support primary care clinicians in providing patient-centered guideline-based chronic pain and opioid management for older adults. Further efforts to improve usability and adaptability for real-world workflows and equitable access for older adults should be prioritized.