Opioids for Chronic Pain: A Look between Patient and Physician

Though many studies have discussed the dangers of various pain killers, including hydrocodone, oxycodone and other opioid, little is actually known about what goes on between patients and their physicians regarding chronic pain and prescription medications.

Researchers from the Roudebush VA Medical Center and the Regenstrief Institute are believed to be the first to analyze the nature of these conversations in regular primary care appointments. Examining patient and physician conversations may help provide better chronic paint treatments.

The study followed 30 patients with chronic pain. They were audio-recorded during visits with their primary care doctor and then interviewed regarding their pain care as well as their relationship with physicians.

"Chronic pain -- pain lasting more than six months -- is a debilitating problem for many individuals," study first author Regenstrief Institute investigator Marianne S. Matthias, Ph.D., a VA research scientist and an adjunct assistant professor of communication studies in the School of Liberal Arts at Indiana University-Purdue University Indianapolis said, via a press release. "Although it is well established that opioid treatment for chronic pain poses numerous uncertainties, little has been reported in previous studies about how patients and their physicians actually discuss these uncertainties in clinic appointments.

"Our study provides a window into how uncertainty about potential addiction and misuse of opioid is managed through patient-physician communication. We heard candid discussions revealing concern by both patients and their physicians about a range of issues including past alcoholism and past marijuana or cocaine use.

"There is an important message here for people with chronic pain and for the doctors who treat them. If patients and their doctors have a relationship marked by mutual trust and a strong therapeutic alliance, they are better positioned to candidly discuss all chronic pain treatment options, including risks and benefits of opioid treatment, with the ultimate goal being to develop the most appropriate and effective treatment plan for each individual patient." said Dr. Matthias, a health services researcher and communication scientist.

Three patterns of physician responses to uncertainty about prescribing opioid were observed in the audio-recordings: reassurance, avoiding opioid and gathering additional information.

More information regarding the study can be found via the journal Patient Education and Counseling.