How Prescribers Discuss Opioid Use/Abuse with Patients

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INDIANAPOLIS — From press reports, it might seem that everyone is talking about opioid analgesics. The question that VA researchers set out to answer, however, is how prescribers were discussing use of the pain relievers with their patients.

A pilot study by researchers from the Richard L. Roudebush VA Medical Center and the Regenstrief Institute, both in Indianapolis, sought to analyze the nature of those conversations in regular primary-care appointments.

Study authors suggest that a better understanding of how patients and doctors discuss the potentially addictive pain medications could ultimately lead to more effective strategies for communicating about chronic pain treatment.

The study, “‘I’m Not Abusing or Anything’: Patient-physician communication about opioid treatment in chronic pain,” was published recently in Patient Education and Counseling, the official journal of the American Academy on Communication in Healthcare and of the European Association for Communication in Healthcare.

For the study, researchers audio-recorded 30 patients with chronic pain during visits with their primary-care doctor. Later, subjects were interviewed about their pain care as well as their relationship with their physicians.

“Chronic pain — pain lasting more than six months — is a debilitating problem for many individuals,” said led author Marianne S. Matthias, PhD, of the VA, Regenstrief Institute and Indiana University-Purdue University Indianapolis. “Although it is well established that opioid treatment for chronic pain poses numerous uncertainties, little has been reported in previous studies about how patients and their physicians actually discuss these uncertainties in clinic appointments.

“Our study provides a window into how uncertainty about potential addiction and misuse of opioids is managed through patient-physician communication. We heard candid discussions revealing concern by both patients and their physicians about a range of issues including past alcoholism and past marijuana or cocaine use.

Three patterns of physician responses to uncertainty about prescribing opioids were observed in the audio-recordings: reassurance, avoiding opioids and gathering additional information, the study notes.

Matthias suggested that awareness of those communication patterns can be useful for healthcare providers and patients.

“If patients and their doctors have a relationship marked by mutual trust and a strong therapeutic alliance, they are better positioned to candidly discuss all chronic pain treatment options, including risks and benefits of opioid treatment, with the ultimate goal being to develop the most appropriate and effective treatment plan for each individual patient,” she said.

1. Matthias MS, Krebs EE, Collins LA, Bergman AA, Coffing J, Bair, MJ. “I’m Not Abusing or Anything”: Patient–physician communication about opioid treatment in chronic pain. Patient Education and Counseling, 2013; 93 (2): 197 DOI:

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