Expectations and communication in opioid pain management: a qualitative study of patients' experience

BACKGROUND: Chronic pain remains a leading cause of patient distress in primary care and effective pain management presents an ongoing challenge in patient-clinician interactions. The prescribing of opioids further contributes to communication and shared decision-making disparities between patients and general practitioners. Gaining greater insight into patients' experiences of opioid treatment is valuable as there still is limited knowledge. Patients' perspectives and expectations can provide important contributions to enhance mutual understanding in clinical encounters. AIM: To explore how patients experience, and what they expect from, pain management consultations regarding opioid use. DESIGN AND SETTING: A qualitative study with patients in rural Örebro County, Sweden. METHOD: Semi-structured interviews were carried out with fifteen chronic pain patients prescribed opioids managed in primary care. The interviews were analyzed using reflexive thematic analysis. RESULT: Two main themes were generated to capture patients experience and their expectations concerning pain management and opioids. Prescribing Validation gives insights to what expectations patients have and how they perceive prescriptions. Renewals are interpreted as validation of the pain condition, and dismissals as mistrust. The Battle for the Steering Wheel capture how patients, based on the lived experience of chronic pain, expect and seek to assert their own expertise in consultations but often feel frustrated over being unheard. CONCLUSION: While education about the biopsychosocial nature of pain may provide a necessary foundation for communication around reducing opioid use, validation of patient experience is pivotal for building a trusting alliance.