TY - JOUR
T1 - A qualitative exploration of chronic pain and opioid treatment among HIV patients with drug use disorders
AU - Isenberg, Sarina R.
AU - Maragh-Bass, Allysha C.
AU - Ridgeway, Kathleen
AU - Beach, Mary C.
AU - Knowlton, Amy R.
N1 - Funding Information:
This study was supported by grants from the National Institute on Drug Abuse (R01 DA019413 and R34 DA034314), the National Institute for Nursing Research (R01NR014050), the Johns Hopkins Center for AIDS Research (1P30AI094189), and the Canadian Institutes of Health Research (146181). The authors wish to thank Ms Kylie Liu for her contribution to the review of the manuscript. The authors would also like to thank members of our Community Advisory Board for their insights and suggestions throughout the course of the study. The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.
Publisher Copyright:
© 2017 Journal of Opioid Management,.
PY - 2017/1/1
Y1 - 2017/1/1
N2 - Objective: The study explored high-risk participants' experiences with pain management regarding clinical access to and use of prescription opioids. Design: Qualitative semistructured interviews and focus groups. Setting: Data were collected August 2014 to May 2015 at an urban community-based research facility in Baltimore City, MD. Participants: HIV participants with chronic pain and a history of illicit drug use. Methods: Qualitative coding and analysis used an iterative, inductive, and thematic approach and coders achieved inter-coder consistency. Results: The authors identified two major themes. First, participants had positive and negative interactions with healthcare providers regarding chronic pain treatment. Participants perceived that providers lacked empathy for their pain and/or were not adequately managing their pain. These interactions resulted in participants seeking new providers or mistrusting the medical system. Further, providers' surveillance of participants' pain treatment regimen contributed to distress surrounding pain management. The second theme centered on participants' pain management experiences with prescribed opioid analgesics. Participants felt they were receiving dosages and classes of analgesics that did not sufficiently address their pain, and consequently modified their dosages or rationed prescription opi-oids. Other participants were reluctant to take analgesics due to their history of illicit drug use. Some participants relapsed to illicit drug use when they felt their prescription opioids did not adequately address their pain needs. Conclusions: Participant struggles with receiving and managing prescribed opi-oid analgesics suggest a need for: therapies beyond these medications; guidelines for providers specific to this population; and harm reduction trainings for providers.
AB - Objective: The study explored high-risk participants' experiences with pain management regarding clinical access to and use of prescription opioids. Design: Qualitative semistructured interviews and focus groups. Setting: Data were collected August 2014 to May 2015 at an urban community-based research facility in Baltimore City, MD. Participants: HIV participants with chronic pain and a history of illicit drug use. Methods: Qualitative coding and analysis used an iterative, inductive, and thematic approach and coders achieved inter-coder consistency. Results: The authors identified two major themes. First, participants had positive and negative interactions with healthcare providers regarding chronic pain treatment. Participants perceived that providers lacked empathy for their pain and/or were not adequately managing their pain. These interactions resulted in participants seeking new providers or mistrusting the medical system. Further, providers' surveillance of participants' pain treatment regimen contributed to distress surrounding pain management. The second theme centered on participants' pain management experiences with prescribed opioid analgesics. Participants felt they were receiving dosages and classes of analgesics that did not sufficiently address their pain, and consequently modified their dosages or rationed prescription opi-oids. Other participants were reluctant to take analgesics due to their history of illicit drug use. Some participants relapsed to illicit drug use when they felt their prescription opioids did not adequately address their pain needs. Conclusions: Participant struggles with receiving and managing prescribed opi-oid analgesics suggest a need for: therapies beyond these medications; guidelines for providers specific to this population; and harm reduction trainings for providers.
KW - Chronic pain management
KW - Drug/substance abuse
KW - HIV/AIDS
KW - Palliative care
KW - Patient engagement in healthcare
KW - Patient-provider communication/conflict
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U2 - 10.5055/jom.2017.0363
DO - 10.5055/jom.2017.0363
M3 - Article
C2 - 28345742
AN - SCOPUS:85016426286
VL - 13
SP - 5
EP - 16
JO - Journal of Opioid Management
JF - Journal of Opioid Management
SN - 1551-7489
IS - 1
ER -