School of Social and Behavioral Health Sciences, 2694Oregon State University, Corvallis, OR, USA.
Department of Health Policy and Management, 41474University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
Am J Health Promot. 2023 Feb;37(2):210-221. doi: 10.1177/08901171221119799. Epub 2022 Sep 2.
To explore factors related to effectiveness of nonpharmacological treatment for opioid-dependent patients suffering with chronic pain.
A qualitative study incorporating individual interviews and focus group interviews.
3 rural Oregon nonopioid pain management clinics.
A 10-week nonpharmacological educational program incorporating cognitive-behavioral therapy, movement therapy, mindfulness, and other skills.
Across sites, we conducted 9 individual interviews with clinic staff and 3 focus group interviews with 34 patients who had participated in the course. Thematic analysis was used to identify themes within and across respondent groups.
Analysis revealed 4 primary themes: program goals; program benefits; characteristics of patients who benefit from the program; coordination of clinic experiences with other care. Several primary findings can be highlighted. The clinics focused on improving patients' quality of life, while opioid use reduction was a potential secondary benefit, driven by patients. Major program benefits included enhanced pain self-management skills, patients' greater assertiveness in communications with healthcare providers, and, in numerous cases, opioid use reduction. Participants were unanimous that predisposition toward active self-management of one's pain was an essential factor for positive outcomes. Patients reported considerable variability in providers' understanding of their clinic participation.
Nonpharmacological approaches for treating chronic pain can be effective for many patients. Clinics teaching these approaches should be more fully integrated into the healthcare system.
探讨与接受非药物治疗的慢性疼痛阿片类药物依赖患者疗效相关的因素。
采用个体访谈和焦点小组访谈相结合的定性研究。
俄勒冈州 3 个农村非阿片类疼痛管理诊所。
为期 10 周的非药物教育计划，结合认知行为疗法、运动疗法、正念和其他技能。
在各个地点，我们对诊所工作人员进行了 9 次个体访谈，对参加课程的 34 名患者进行了 3 次焦点小组访谈。采用主题分析方法识别受访者群体内部和之间的主题。
分析揭示了 4 个主要主题：项目目标；项目效益；受益于该项目的患者特征；诊所体验与其他护理的协调。有几个主要发现可以突出。这些诊所专注于提高患者的生活质量，而减少阿片类药物的使用是患者推动的潜在次要益处。主要的项目效益包括增强疼痛自我管理技能、患者在与医疗保健提供者沟通时更有主见，以及在许多情况下减少阿片类药物的使用。参与者一致认为，积极主动地管理自己疼痛的倾向是取得积极结果的一个重要因素。患者报告称，提供者对他们参与诊所的理解存在相当大的差异。
治疗慢性疼痛的非药物方法对许多患者可能有效。教授这些方法的诊所应更充分地融入医疗保健系统。
