Perceptions of Evidence-Based Chronic Pain Management of Primary Care Providers

Background: One of the Social Work Grand Challenges is to address health inequity. Within this framework, social workers must address issues of access to healthcare. Social work is uniquely situated to address health disparities through research, practice, and policy. Chronic pain is a serious issue that effects millions of Americans each year and most people receive chronic pain treatment from their primary care providers. Primary care providers want to provide the best care for their patients; however, the often do not have the knowledge and resources they need. This creates disparities, and often exacerbates, who has access to evidence-based chronic pain management. Yet, little is known about the perspective of primary care providers and the barriers and facilitators they experience to using evidence-based chronic pain management with their patients. To address this gap, the current study seeks to address the following question, what are primary care providers’ perceptions of strategies to implement evidence-based chronic pain management strategies?

Methods: We conducted qualitative semi-structured telephone interviews with outpatient adult primary care providers (i.e. MD, DO, PA, DNP). We used purposive sampling to include primary care providers at both academic and non-academic centers. Participants were recruited from a large health system and through snowball sampling. All interviews were transcribed verbatim. We analyzed the interviews using thematic analysis.

Results: We interviewed 21 primary care providers to understand barriers and facilitators to providing evidence-based chronic pain management. About half (n=11) were men and most (n=17) were white. About half (n=10) work at an academic center and most (n=18) participate in some form of teaching. Primary care providers currently use both pharmacologic and non-pharmacology strategies to treat chronic pain. Barriers and facilitators occur at the patient, provider, and system levels. At the patient level, physical conditions, patient expectations, previous treatment, psychological factors, and substance abuse all play a role in managing chronic pain. At the provider level, measuring pain, the patient-provider relationship, provider experience, and provider fear contribute to barriers and facilitators. At the system-level, availability, effectiveness of treatment, insurance, referrals, time, and non-traditional factors all play a role in primary care providers ability to treat patients with chronic pain.

Conclusions and Implications: Rapport-building and the patient-provider relationship may help to overcome patient-level barriers to chronic pain management. Leveraging in-house and community resources may help address system-level barriers. Future research should investigate how these themes generalize to a larger group of primary care providers. Social work scholars should apply ecological perspectives to address health inequities that exist as a result of implementation barriers of evidence-based chronic pain management.