Open Access Open Access  Restricted Access Subscription or Fee Access

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

Mayra Massey, MMFT, Carissa Carissa van den Berk Clark, PhD, MSW, Jocelyn Fowler, MMFT, Jeffrey F. Scherrer, PhD


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 audiorecorded, 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.


opioids, patient-provider communication, primary care, chronic pain

Full Text:



Krebs EE, Gravely A, Nugent S, et al.: Effect of opioid vs nonopioid medications on pain-related function in patients with chronic back pain or hip or knee osteoarthritis pain: The SPACE randomized clinical trial. JAMA. 2018; 319(9): 872-882.

Mojtabai R: National trends in long-term use of prescription opioids. Pharmacoepidemiol Drug Saf. 2018; 27: 526-534.

Centers for Disease Control and Prevention: Opioid overdose. Guideline for prescribing opioids for chronic pain. Available at Accessed December 6, 2017.

Guy GP Jr, Zhang K, Bohm MK, et al.: Vital signs: Changes in opioid prescribing in the United States, 2006–2015. MMWR Morb Mortal Wkly Rep. 2017; 66: 697-704.

Dowell D, Haegerich TM, Chou R: CDC guideline for prescribing opioids for chronic pain—United States, 2016. MMWR Recomm Rep. 2016; 65: 1-49.

Hurstak EE, Kushel M, Chang J, et al.: The risks of opioid treatment: Perspectives of primary care practitioners and patients from safety-net clinics. Subst Abus. 2017; 38(2): 213-221.

Agarin T, Trescot AM, Agarin A, et al.: Reducing opioid analgesic deaths in America: What health providers can do. Pain Physician. 2015; 18: E307-E322.

Hughes HK, Korthuis PT, Saha S, et al.: A mixed methods study of patient-provider communication about opioid analgesics. Patient Educ Couns. 2015; 98: 453-461.

Olsen Y, Daumit GL: Opioid prescribing for chronic nonmalignant pain in primary care: Challenges and solutions. Adv Psychosom Med. 2004; 25: 138-150.

Esquibel AY, Borkan J: Doctors and patients in pain: Conflict and collaboration in opioid prescription in primary care. Pain. 2014; 155: 2575-2582.

Upshur CC, Bacigalupe G, Luckman R: “They don't want anything to do with you”: Patient views of primary care management of chronic pain. Pain Med. 2010; 11: 1791-1798.

Nicolaidis C: Police officer, deal-maker, or health care provider? Moving to a patient-centered framework for chronic opioid management. Pain Med. 2011; 12: 890-897.

Baxter LA, Braithwaite DO: Engaging Theories in Interpersonal Communication: Multiple Perspectives. Thousand Oaks, CA: SAGE Publications Inc, 2008.

Heritage J, Maynard DW: Communication in Medical Care: Interactions between primary care physicians and patients. Cambridge and New York: Cambridge University Press, 2006.

Matthias MS, Krebs EE, Collins LA, et al.: “I’m not abusing or anything”: Patient–physician communication about opioid treatment in chronic pain. Patient Educ Couns. 2013; 93: 197-202.

Matthias MS, Johnson NL, Shields CG, et al.: “I’m not gonna pull the rug out from under you”: Patient-provider communication about opioid tapering. J Pain. 2017; 18(11): 1365-1373.

Cella D, Riley W, Stone A, et al.: The Patient-Reported Outcomes Measurement Information System (PROMIS) developed and tested its first wave of adult self-reported health outcome item

banks: 2005-2008. J Clin Epidemiol. 2010; 63: 1179-1794.

Deyo RA, Dworkin SF, Amtmann D, et al.: Report of the NIG task force on research standards for chronic low back pain. J Pain. 2014; 39(4): 1128-1143.

Kroenke K, Strine TW, Spritzer RL, et al.: The PHQ-8 as a measure of current depression in the general population. J Affect Disord. 2009; 114(1-3): 163-173.

Spitzer RL, Kroenke K, Williams JB, et al.: A brief measure for assessing generalized anxiety disorder: The GAD-7. Arch Intern Med. 2006; 166(10): 1092-1097.

Padgett DK: Qualitative Methods in Social Work Research: Challenges and Rewards. Thousand Oaks, CA: Sage Publications, 1998.

Anderson LA, Dedrick RF: Development of the trust in physician scale: A measure to assess interpersonal trust in patient-physician relationships. Psychol Rep. 1990; 67(3 suppl): 1091-1100.

Frank JW, Lovejoy TI, Becker WC, et al.: Patient outcomes in dose reduction or discontinuation of long-term opioid therapy: A systematic review. Ann Intern Med. 2017; 167(3): 181-191.

Gudin JA, Brennan MJ, Harris D, et al.: Reduction of opioid use and improvement in chronic pain in opioid-experienced patients after topical analgesic treatment: An exploratory analysis. Postgrad Med. 2018; 130: 42-51.



  • There are currently no refbacks.