Discussions between patients with chronic pain and their primary care provider about opioids and pain relief during routine clinic encounters.

Objective: Existing studies indicate low levels of trust and shared decision making exist in the process of prescribing opioids for noncancer pain. Patient-provider communication has not been compared between patients receiving non-opioid pain medication, and those receiving opioids. This pilot study evaluated communication about pain management between patients with noncancer pain and their provider.

Design: Patient encounters with a primary care provider (PCP) were audio-recorded, followed by a short patient questionnaire to measure physician trust, depression, and anxiety.

Setting: Data were collected (October 2016-May 2017) at a primary care clinic in Saint Louis, MO.

Patients: Patients with noncancer chronic pain, receiving a nonsteroidal anti-inflammatory drug (NSAID) or an opioid with and without an NSAID.

Methods: Medical conversation analysis guided data interpretation of codes and themes.

Results: Themes were framed around stages of the routine PCP encounter (ie, opening, presenting complaint, examination, diagnosis, treatment, and closing). Themes within these stages included: managing stability (opening stage), fixation with pain (presenting complaint), changing the subject (examination stage), difficult conversations (diagnosis stage), patients chose protest or acceptance (treatment), and taking what you can get (closing).

Conclusions: Much of the treatment of chronic pain, as a result of opioid prescriptions, revolves around negotiations about whether to use opioids or not. Patient education is required to disseminate realistic expectations regarding pain relief and risks of long-term opioid use. This may reduce patients' focus on pain severity and difficult conversations and increase shared decision making.