Abstract
BackgroundCurrent literature describes the limits and pitfalls of using opioid pharmacotherapy for chronic pain and the importance of identifying alternatives. The objective of this study was to identify the practical issues patients and providers face when accessing alternatives to opioids, and how multiple parties view these issues.MethodsQualitative data were gathered to evaluate the outcomes of acupuncture and chiropractic (A/C) services for chronic musculoskeletal pain (CMP) using structured interview guides among patients with CMP (n = 90) and primary care providers (PCPs) (n = 25) purposively sampled from a managed care health care system as well as from contracted community A/C providers (n = 14). Focus groups and interviews were conducted patients with CMP with varying histories of A/C use. Plan PCPs and contracted A/C providers took part in individual interviews. All participants were asked about their experiences managing chronic pain and experience with and/or attitudes about A/C treatment. Audio recordings were transcribed and thematically coded. A summarized version of the focus group/interview guides is included in the Additional file 1.ResultsWe identified four themes around opioid use: (1) attitudes toward use of opioids to manage chronic pain; (2) the limited alternative options for chronic pain management; (3) the potential of A/C care as a tool to help manage pain; and (4) the complex system around chronic pain management. Despite widespread dissatisfaction with opioid medications for pain management, many practical barriers challenged access to other options. Most of the participants’ perceived A/C care as helpful for short term pain relief. We identified that problems with timing, expectations, and plan coverage limited A/C care potential for pain relief treatment.ConclusionsThese results suggest that education about realistic expectations for chronic pain management and therapy options, as well as making A/C care more easily accessible, might lead to more satisfaction for patients and providers, and provide important input to policy makers.Trial registrationClinicalTrials.gov NCT01345409, date of registration 28/4/2011Electronic supplementary materialThe online version of this article (doi:10.1186/s12875-016-0566-0) contains supplementary material, which is available to authorized users.
Highlights
Current literature describes the limits and pitfalls of using opioid pharmacotherapy for chronic pain and the importance of identifying alternatives
While opioid use was not a focus of the study, it emerged as a dominant theme in the data analysis of participants’ use of A/C for chronic musculoskeletal pain (CMP) management
Primary care provider (PCP) frequently talked about opioids when asked, “What are the biggest barriers and challenges in working with your pain patients?” Discussions about opioids were sorted into four main themes, presented below
Summary
Current literature describes the limits and pitfalls of using opioid pharmacotherapy for chronic pain and the importance of identifying alternatives. While primary care providers (PCPs) are often aware of the risks and limitations of prescribing opioids as a monotherapy for pain, primary care practices often lack readily available systematic, integrated, and interdisciplinary treatment options [24, 25] or support for making prescribing decisions [26]. Both physicians and their patients are frustrated when alternatives to opioid therapy or tapering off opioid therapy are needed but effective and accessible alternatives are lacking
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