Pain management study reveals patient confusion about opioid addiction

The study used semi-structured open-ended telephone interviews with 23 patients (mostly women, ages 18 to 65) discharged from the Hospital of the University of Pennsylvania after being seen in the emergency department during a four-month period in 2014, for pain related to broken bones in the arms or legs, kidney stones or musculoskeletal back injury. Although the patients discussed a variety of topics related to their experiences with communication around pain, the main themes of the interviews included opioid dependence and addiction, and patient-provider communication about pain management. The themes patients revealed around opioid dependence included:

1) fear of developing dependence or addition,

2) worries about following prescribed dosing preventing the possibility of addiction,

3) relying on media and other individuals as a source of information about opioids, and

4) awareness of physicians' need to balance patients' pain management needs and safe opioid prescribing guidelines.

"It was interesting to find that patients believe that taking an opioid as prescribed prevents the possibility of addiction, but also that patients are learning about opioids from television and from friends and acquaintances -- not healthcare providers," said senior author Zachary F. Meisel, MD, MPH, MS, assistant professor and attending physician in the department of Emergency Medicine, who oversaw the study led by Robert J. Smith, BS, a medical student at Penn. "There's clearly a significant need for emergency departments to improve education around the risks of opioid misuse."

There were also several themes that emerged around patient-provider communication about pain management. Patients often reported that they desired engagement in decisions about the treatment plan, better communication about the cause of their pain, consideration of how the pain is affecting their life, and more empathy from providers, and they also felt that fragmentation in communication between providers was detrimental to their treatment.

"Patients realize that emergency departments are busy places, but that doesn't reduce their desire to have meaningful interactions with their care providers," said Meisel. "Patients want to be given information in a straight-forward way and then listened to, so that they leave feeling like they know what was causing their pain, what their pain management options were, and that their treatment preferences were heard."

The researchers are now using the data from this study to develop short video narratives of patient stories related to pain in the emergency department, which will then be tested as an intervention to improve patient understanding of their pain management options and the risks associated with opioid misuse.