A qualitative exploration of chronic pain and opioid treatment among HIV patients with drug use disorders

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.