Table 2.

Clinicians' Perspectives on Pain and Opioid Management

Pain as Time Drain: Clinician Perspectives
Theme: Pain management takes time from other patients and health concerns
“My pain management patients drain my time. I don't want to say ‘drain’ but it's true, at least that's how I feel. My perception is that they drain my time and that puts me behind in the rest of my schedule, because there's always a struggle… And that takes away from the other patients that I need to spend more time with.”
“From a patient's perspective, pain and mental health and well-being are the most, are frequently the most pressing issues, and understandably so. But there also are other big things that could be going on with people from a health perspective that are important, too, and it all needs to fit into the time. That's hard.”
Theme: Pain and opioid management are often fraught with conflict
“[In] terms of trajectory with patients… either if I'm inheriting them or if I'm starting over with them, or even starting with these new patients, [I try] to establish some functional goals… I totally do not have time to do any of [it] but it's not an option [not to]. If you don't do it the whole relationship ends up being a disaster… because every time you see them you're just arguing about whether or not it's [the pain's] better, whether it [opioid medication] makes them better or worse…”
Theme: The intensity and chronicity of patient suffering weighs on providers
“[If] you ask anybody in [this clinic] what percentage of our patients are on chronic opioids, they'll tell you some completely inflated number… I think [it's] because [of] the psychologic[al] space that these [CNCP] patients take up in people's minds. And that's because nobody's suffering more than a person with chronic pain… so you develop these really passionate and intense relationships with people because… they're trusting you with their suffering and you want to help them. And sometimes we help people and they move in a positive direction and sometimes we don't… [The] other thing that would happen is… you're trying to get them healthier and they'd no-show to all your visits and they would always come to… their refill appointment.”
  • CNSP, chronic noncancer pain.