Doctors and patients in pain: Conflict and collaboration in opioid prescription in primary care

Pain. 2014 Dec;155(12):2575-2582. doi: 10.1016/j.pain.2014.09.018. Epub 2014 Sep 28.


Use of chronic opioid therapy (COT) for chronic noncancer pain has dramatically increased in the United States. Patients seek compassionate care and relief while physicians struggle to manage patients' pain effectively without doing harm. This study explores the narratives of chronic noncancer pain patients receiving chronic opioid therapy and those of their physicians to better understand the effects of COT on the doctor-patient relationship. A mixed method study was conducted that included in-depth interviews and qualitative analysis of 21 paired patients with chronic pain and their physicians in the following groups: patients, physicians, and patient-physician pairs. Findings revealed that patients' narratives focus on suffering from chronic pain, with emphasis on the role of opioid therapy for pain relief, and physicians' narratives describe the challenges of treating patients with chronic pain on COT. Results elucidate the perceptions of ideal vs difficult patients and show that divergent patterns surrounding the consequences, utility, and goals of COT can negatively affect the doctor-patient relationship. The use of paired interviews through a narrative lens in this exploratory study offers a novel and informative approach for clinical practice and research. The findings have significant implications for improving doctor-patient communication and health outcomes by encouraging shared decision making and goal-directed health care encounters for physicians and patients with chronic pain on COT.

Perspective: This study found patterns of understanding pain, opioid pain medications, and the doctor-patient relationship for patients with chronic pain and their physicians using a narrative lens. Thematic findings in this exploratory study, which include a portrayal of collaborative vs conflictual relationships, suggest areas of future intervention and investigation.

Keywords: Chronic noncancer pain; Chronic opioid therapy; Doctor–patient relationship; Narrative medicine; Opiate epidemic; Pain management.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Analgesics, Opioid / therapeutic use*
  • Chronic Pain / drug therapy*
  • Conflict, Psychological*
  • Cooperative Behavior*
  • Drug Prescriptions / statistics & numerical data*
  • Female
  • Humans
  • Male
  • Middle Aged
  • Pain Management
  • Physician-Patient Relations*
  • Practice Patterns, Physicians'
  • Primary Health Care / statistics & numerical data
  • Young Adult


  • Analgesics, Opioid