Mixed Methods Study of Patient and Primary Care Provider Perceptions of Chronic Pain Treatment

•Patient-centered communication is difficult in pain management discussions•Interventions need to overcome frustration, fear and discordant goals or expectations•Lack of time and familiarity impede use of patient assessment or communication tools•Functional goals and integrated behavioral health opportunities are recommended A mixed-method study involving patient focus groups and survey of primary care providers (PCPs) sought to compare perspectives about chronic pain (CP) and its treatment. Our goal was to identify needs and barriers for facilitating patient-centered care. Two focus groups of CP patients from a single academic medical center explored interactions with PCPs and their understandings, experiences, and expectations of CP treatment. They were also asked their opinions about self-assessment/communication tools. We compared themes with survey data from two PCP research networks. CP patients understand opioid risks and fear PCP judgement and condescension, while sensing PCP fear and avoidance of opioid prescribing. PCPs are dissatisfied with their ability to provide optimal CP care, despite feeling that patients are generally satisfied with their clinic visits. Evaluation tools, especially assessment of functional activities, are favorably viewed by all, but deemed time prohibitive. Patients’ understanding of opioid risks, desire for attention on functional goals and behavioral treatment may be greater than PCPs perceive. Such gaps in understanding and attitudes, if recognized, could support high-quality communication and interventional strategies. These findings guide patient-PCP communication toward alignment of treatment goals and enhanced coordination of care.