Perspective of Pain Clinicians in Three Global Cities on Local Barriers to Providing Care for Chronic Noncancer Pain Patients

Power of narrative: a case study about documenting private insightful experiences while dealing with pain and associated disability

Objective

People adjusting to living with a chronic disability, such as chronic pain, seek support and resources from societal systems, including health systems, to help them cope with this reality. This case study describes the use of a digital health platform designed to help in that quest.

Method

MyHealthMyRecord (MHMR), is being developed to record, register and curate personal private experiences of a chronic condition. MHMR allows users to record and log short (30-90s) personal and private audio-videos of their accommodation-seeking journey in a way that can be encrypted, registered, curated and shared privately. This case study describes the use of a prototype version of the platform by a participant co-designer who experienced a sudden onset of a chronic pain condition, of undetermined origin. System use began three months after the onset of the condition and just after being discharged from several months of hospitalization without any definitive diagnosis.

Result

During a three-month period, 65 short unstructured contributions were authored and logged. This paper presents a qualitative analysis of that content. The clips used various communication styles that documented experiences, concerns, issues, positive and negative interactions and pain episodes. Using thematic analysis with open coding, three domains (person-facing, accessibility and system-facing) and eight themes (pain, joy, therapy, environmental, recommendations, technical, culture and communication) were identified. Comments about pain, stress, etc., were the most common and occurred in 75% of all videos while technical and therapy/physio related comments were the fewest and occurred in 3 and 9% of the videos, respectively.

Conclusion

We conclude that it is possible to create recordings of events, thoughts, reflections and issues on different aspects affecting an individual's health and well-being impact, including effects of the chronic condition as well as tangential outcomes such as accessibility (or lack of it), using MHMR over a longer period of time. The next steps will be to develop functionality to annotate the recordings, automatically analyze and summarize collections of recordings to make them consumable, useful and understandable to the individual and others, and then to share those analyses and summaries with others. In addition, evaluate this functionality longitudinally with more users.

Chronic non-cancer pain management - insights from Australian general practitioners: a qualitative descriptive study

BACKGROUND

The study explored the experiences and perceptions of GPs regarding the management of chronic non-cancer pain (CNCP). Specifically, participants were asked to identify perceived enablers and barriers to CNCP care and how the care of patients with CNCP may be improved.

METHODS

The study utilised a qualitative descriptive methodology. General practice in Western Australia. The sample was purposive with 12 Australian GPs from predominantly metropolitan locations and with experience in managing CNCP. Semi structured interviews were conducted. Each interview was of 45-60min duration. All interviews were audio recorded and transcribed using a secure transcription service. Thematic analysis developed themes inductively and deductively.

RESULTS

Themes emerged regarding: the importance of a holistic and personalised approach; the important role of a coordinating GP; the need for an evidence-based approach to opioid management; concerns relating to access to multidisciplinary services; the importance of clinician and patient education regarding CNCP; and an acknowledgement of the challenges for doctors and patients in managing CNCP.

CONCLUSIONS

Currently, the management of CNCP in Australia is challenging. Notable challenges include: difficulties with continuity of patient care; challenges with patient expectations of treatment, in particular opioid medications; difficulty with access to the health services required to enable holistic care; and the need for improved pain education in the community. The breadth of these challenges suggests there is a need for supportive organisational and structural considerations in the healthcare system to enable optimal care of CNCP in the community.

The Impact of a Primary Care, Pharmacist-Driven Intervention in Patients with Chronic Non-Cancer Pain-A Pilot Study

Background: Chronic pain is a prevalent condition, experienced by 15.3% to 55% of Canadians, that is difficult to manage. With their broad accessibility and expertise on drugs, primary care pharmacists can help patients optimize their pain management. Methods: The objective of this study is to examine the effectiveness of a primary care, pharmacist-driven chronic pain intervention on pain and quality of life in patients with chronic non-cancer pain. A three-month naturalistic prospective study was conducted in primary care settings (five community pharmacies and one Family Health Team) across Ontario, Canada with a total of six pharmacists and 19 study participants. The primary care, pharmacist-driven chronic pain intervention consisted of patient assessments, medication reviews, care plan recommendations, and patient education. In order to evaluate the effectiveness of the intervention, pain intensity, pain interference, and quality of life were evaluated at baseline and at follow up (week 2 and month 3). Results: Trends towards improvement in pain and quality of life were found, however, these improvements were not statistically significant at follow up (month 3). Conclusions: This study provides the foundational research required to better understand the impact of Ontario pharmacists' extended role in pain management in non-cancer patients within multiple primary care settings (e.g., Family Health Team, etc.) and has illustrated the importance of modifying and customizing care plans in patients with chronic pain. A larger sample size with tailored outcome measures may be necessary to better highlight significant improvements in pain and quality of life in patients with chronic non-cancer pain using a primary care, pharmacist-driven intervention.