Researchers Explore Patient Experience of Interventional Pain Management

Hoping to get a better understanding of the patient experience when seeking treatment for chronic pain, researchers in Sweden recently published a qualitative report examining the patient point of view in interventional pain management.

The authors reported that other studies have shown that patients describe being made to feel responsible for their pain, resulting in feelings of disempowerment and stigmatization.

In developed industrialized countries, roughly 20% of the population suffers from chronic pain (CP), which is defined as pain persisting for longer than normal or expected (about 3 to 6 months) or is associated with a progressive nonmalignant disease. It is its own disease entity and not a symptom of underlying diseases.

The authors of this study said it is still unclear whether the initial source of the pain—such as from synovial joints, nerve damage, and intervertebral discs, and nerve damage—are also involved in the continued chronic pain long after the injury has occurred.

The 2 main approaches for coping with pain are interventional pain management (IPM), which focuses on the source and treatment of the pain trigger, while pain rehabilitation programs (PRPs) focus on the psychological aspects of pain.

“Over the last decades, the gold standard treatment of non-cancer-related chronic pain in Sweden has been PRPs; IPM has only been used sparingly,” the authors said.

The study was conducted at one of the few IPM centers in Sweden, which provides 85% of the nerve blocks administered in the country.

Nineteen participants agreed to be interviewed; the interviews were transcribed and analyzed thematically. Of the 19 patients, 11 were women and 8 were men. Ten subjects had suffered from pain for 2 to 6 years, and 9 for 12 to 40  years.

Before coming to the clinic, they had been treated conservatively by primary care physicians; 8 had undergone acceptance and commitment therapy as part of a PRP; and 14 were seen by orthopedic surgeons, with 4 patients having surgery.

The interviews were conducted by phone, transcribed, analyzed, and coded.

The subjects’ perceptions focused on 3 key themes:

• Individual themes, or intrinsic factors, that were related to and expressed by the patients themselves
• Health care themes that focused on the services provided (the providers were viewed as caregivers) including the process of tests and retests, the encounters and interactions with professionals, and their availability
• Outcome themes that focused on the outcomes and patient goals

The researchers merged the themes and structured them into a model in order to understand their experience of IPM. The overwhelming sentiment that emerged is that patients felt empowered by their experience with IPM as a result of gaining knowledge, having questions asked and answered, “and they felt safe and listened to,” the authors said.

Ultimately, the researchers said, they hoped their results “might provide a step towards a more integrated approach between the interventional and rehabilitation-focused communities because many patients with chronic pain need both kinds of treatment.”

“If empowerment is a major factor in the positive effects of interventional pain management, it is important to facilitate and not hinder empowerment," the authors concluded.

Reference

Hambraeus J, Hambraeus KS, Sahlen KG. Patient perspectives on interventional pain management: thematic analysis of a qualitative interview study. BMC Health Serv Res. Published online July 1, 2020. doi:10.1186/s12913-020-05452-7