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Understanding management of poorly controlled pain in community-dwelling analgesic users: a qualitative study

International Journal of Clinical Pharmacy volume 43, pages 928–937 (2021)Cite this article

Abstract

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 6 months 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 77 years 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.

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Acknowledgements

The authors would like to express their appreciation and thanks to Lex Milne for her ongoing commitment, advice and assistance during the completion of this study. The authors also wish to gratefully acknowledge the pharmacists who agreed to distribute the study invitations to recruit prospective patients and all the participants who gave up their valuable time to be involved in the study. Their preparedness and willingness to so generously share their personal thoughts and feelings was highly valued and greatly appreciated. Without their support this study would not have been possible.

Funding

No funding was received for this project.

Author information

Affiliations

  1. Department of Pharmacy, Bendigo Health, Bendigo, VIC, Australia

    Andrea J. Wilson

  2. Department of Pharmacy and Biomedical Sciences, LaTrobe University, Bendigo, VIC, Australia

    Andrea J. Wilson

  3. School of Rural Medicine, Faculty of Medicine and Health, University of New England, Armidale, NSW, 2351, Australia

    M. Joy Spark

Authors
  1. Andrea J. Wilson
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Correspondence to M. Joy Spark.

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Appendix

Appendix

Semi-structured interview guide

Background information

Do you mind if I ask you how old you are?

What is your occupation? If retired, what was your previous occupation?

What chronic pain condition are you suffering from that requires the use of medication(s)?

Expand on condition (e.g. symptoms, severity, length of time had condition)

On a scale of O to 10, with zero being no pain and ten being the highest amount of pain you can imagine, what number would you give that best describes your average pain over the last week?

Drug regimen used

What medications are you currently taking?

Why? And what are you taking each of these for?

Can you please explain to me how you are taking these medications?

What other medications have you used in the past?

In what dosage form?

What was the outcome?

Why did you change treatment (in each case)?

* Explore if relevant—Did you have any concerns about taking morphine?

Pain

How does your pain affect your daily activities/life?

How do you manage this?

Can you tell me if you have had to make adjustments to accompany this?

Are there certain things that.you have found to make you pain worse?

Can you tell me about these?

Who do you talk to about your pain? (e.g. doctor, pharmacist, family, friends, neighbours)

Why them?

What did they suggest?

How did you find that (the information they gave you)? What was the outcome?

Who else would you have like to have spoken to?

If not, why not?

Pain management

As opposed to pain itself, who have you discussed your pain management with?

Why them?

What advice did they give?

How did you find that?

How do you feel about the way your pain is managed?

Effective control or not?

As good as it gets?

Happy about this?

Do your pain levels fluctuate? How do you manage that?

If you had any concerns, did you discuss these with anyone?

Who?

What was the outcome?

Were you happy with this?

What things have you tried apart from the medications to help relieve your pain?

Please outline (e.g. exercise program, relaxation therapy, physiotherapy, massage, TENS, acupuncture, glucosamine, yoga, meditation, etc..)

Expand on effectiveness

Is it still used? If not, why not?

Possible follow-up questions

How often do you talk to any health professional about your pain?

Who? (e.g. doctor, pharmacist, etc..)

What do you tell them?

What was the response/outcome?

Were you satisfied? If not, why not?

Are you satisfied with the information provided to you? (Please expand)

If not, why not? Why is that?

Medications

How do you feel about taking: (1) painkillers and (2) other medications?

Can you tell me why you think that is?

Scared of side effects, doubtful of effectiveness, addiction, etc…(Please expand)

How have you found the costs of treatment?

Have you been made aware or offered any other medication options?

Can you tell me what the doctor and/or pharmacist told you about your medication(s)?

How much information have you been given about your medications?

Who from?

How could this be improved?

What could be done to improve access to information and support for chronic pain sufferers?

Conclusion

Do you have anything else to add?

Could I send you a copy of the important themes that emerge from your interview so that you can check over them?

If yes, where shall I send them to?

Please supply postal details or an e-mail address

Would you like a summary of the results from the study sent to you around November/December?

If yes, where shall I send them to?

Please supply postal details or an e-mail address

Thank you very much for your involvement in my study, it is very much appreciated.

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Wilson, A.J., Spark, M.J. Understanding management of poorly controlled pain in community-dwelling analgesic users: a qualitative study. Int J Clin Pharm 43, 928–937 (2021). https://doi.org/10.1007/s11096-020-01198-8

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  • DOI: https://doi.org/10.1007/s11096-020-01198-8

Keywords

  • Analgesics
  • Chronic pain management
  • Community
  • Qualitative research