VA Health Services Research and Development Center of Excellence on Implementation of Evidence-Based Practices, Roudebush VAMC, Indianapolis, IN 46202, USA.
Pain Med. 2010 Nov;11(11):1688-97. doi: 10.1111/j.1526-4637.2010.00980.x.
Pain is the most commonly reported symptom in primary care and is a leading cause of disability. Primary care providers (PCPs) face numerous challenges in caring for patients with chronic pain including communication and relational difficulties.
The objective of the study was to elicit providers' perspectives on their experiences in caring for patients with chronic pain.
The design used was a qualitative study using open-ended, in-depth interviews.
Twenty providers (10 men, 10 women) from five different clinics were interviewed at the Roudebush Veterans Affairs Medical Center.
Three broad themes emerged from the analysis: 1) providers emphasized the importance of the patient-provider relationship, asserting that productive relationships with patients are essential for good pain care; 2) providers detailed difficulties they encounter when caring for patients with chronic pain, including feeling pressured to treat with opioids, believability of patients' reports of pain, worries about secondary gain/diversion, and "abusive" or "difficult" patients; and 3) providers described the emotional toll they sometimes felt with chronic pain care, including feeling frustrated, ungratified, and guilty.
Findings were interpreted within a model of patient-centered care.
The clinical implications of these findings are two-fold. First, PCPs' needs cannot be ignored when considering pain care. PCPs need support, both instrumental and emotional, as they care for patients with chronic pain. Second, improving PCPs' patient-centered communication skills-including demonstrating empathy and encouraging shared decision-making-holds promise for alleviating some of the strain and burden reported by providers, ultimately leading to improved patient care.
疼痛是初级保健中最常见的报告症状，也是导致残疾的主要原因。初级保健提供者（PCP）在治疗慢性疼痛患者时面临许多挑战，包括沟通和关系困难。
本研究旨在了解提供者在照顾慢性疼痛患者方面的经验。
使用的设计是使用开放式、深入访谈的定性研究。
在 Roudebush 退伍军人事务医疗中心，从五个不同诊所采访了 20 名提供者（10 名男性，10 名女性）。
从分析中出现了三个广泛的主题：1）提供者强调患者-提供者关系的重要性，断言与患者建立富有成效的关系对于良好的疼痛护理至关重要；2）提供者详细说明了他们在照顾慢性疼痛患者时遇到的困难，包括感到有压力要用阿片类药物治疗、患者疼痛报告的可信度、对继发获益/转移的担忧，以及“虐待”或“困难”的患者；3）提供者描述了他们在慢性疼痛护理中有时感到的情绪困扰，包括感到沮丧、不满足和内疚。
研究结果在以患者为中心的护理模式内进行了解释。
这些发现的临床意义有两方面。首先，在考虑疼痛护理时，不能忽视 PCP 的需求。PCP 在照顾慢性疼痛患者时需要支持，包括工具性和情感性支持。其次，提高 PCP 以患者为中心的沟通技巧，包括表现出同理心和鼓励共同决策，有望缓解提供者报告的一些压力和负担，最终导致改善患者护理。
