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

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.