The patient-provider relationship in chronic pain care: providers' perspectives

Pain Med. 2010 Nov;11(11):1688-97. doi: 10.1111/j.1526-4637.2010.00980.x.


Background: Pain is the most commonly reported symptom in primary care and is a leading cause of disability. Primary care providers (PCPs) face numerous challenges in caring for patients with chronic pain including communication and relational difficulties.

Objective: The objective of the study was to elicit providers' perspectives on their experiences in caring for patients with chronic pain.

Design: The design used was a qualitative study using open-ended, in-depth interviews.

Participants: Twenty providers (10 men, 10 women) from five different clinics were interviewed at the Roudebush Veterans Affairs Medical Center.

Results: Three broad themes emerged from the analysis: 1) providers emphasized the importance of the patient-provider relationship, asserting that productive relationships with patients are essential for good pain care; 2) providers detailed difficulties they encounter when caring for patients with chronic pain, including feeling pressured to treat with opioids, believability of patients' reports of pain, worries about secondary gain/diversion, and "abusive" or "difficult" patients; and 3) providers described the emotional toll they sometimes felt with chronic pain care, including feeling frustrated, ungratified, and guilty.

Findings: Findings were interpreted within a model of patient-centered care.

Conclusions: The clinical implications of these findings are two-fold. First, PCPs' needs cannot be ignored when considering pain care. PCPs need support, both instrumental and emotional, as they care for patients with chronic pain. Second, improving PCPs' patient-centered communication skills-including demonstrating empathy and encouraging shared decision-making-holds promise for alleviating some of the strain and burden reported by providers, ultimately leading to improved patient care.

Publication types

  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, Non-P.H.S.

MeSH terms

  • Adult
  • Chronic Disease
  • Female
  • Health Knowledge, Attitudes, Practice*
  • Health Personnel / psychology
  • Health Personnel / statistics & numerical data*
  • Humans
  • Male
  • Middle Aged
  • Nurse Practitioners / psychology
  • Nurse Practitioners / statistics & numerical data
  • Pain*
  • Patient-Centered Care
  • Pharmacists / psychology
  • Pharmacists / statistics & numerical data
  • Physicians / psychology
  • Physicians / statistics & numerical data
  • Professional-Patient Relations*