Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Multicenter Study
. 2017 Mar 20;18(1):41.
doi: 10.1186/s12875-017-0608-2.

Barriers and facilitators to use of non-pharmacological treatments in chronic pain

William C Becker  1   2 , Lindsey Dorflinger  3 , Sara N Edmond  4   5 , Leila Islam  6 , Alicia A Heapy  4   5 , Liana Fraenkel  4   5
Affiliations
Multicenter Study

Barriers and facilitators to use of non-pharmacological treatments in chronic pain

William C Becker et al. BMC Fam Pract. .

Abstract

Background: Consensus guidelines recommend multi-modal chronic pain treatment with increased uptake of non-pharmacological pain treatment modalities (NPMs). We aimed to identify the barriers and facilitators to uptake of evidence-based NPMs from the perspectives of patients, nurses and primary care providers (PCPs).

Methods: We convened eight separate groups and engaged each in a Nominal Group Technique (NGT) in which participants: (1) created an individual list of barriers (and, in a subsequent round, facilitators) to uptake of NPMs; (2) compiled a group list from the individual lists; and (3) anonymously voted on the top three most important barriers and facilitators. In a separate process, research staff reviewed each group's responses and categorized them based on staff consensus.

Results: Overall, 26 patients (14 women) with chronic pain participated; their mean age was 55. Overall, 14 nurses and 12 PCPs participated. Seven healthcare professionals were men and 19 were women; the mean age was 45. We categorized barriers and facilitators as related to access, patient-provider interaction, treatment beliefs and support. Top-ranked patient-reported barriers included high cost, transportation problems and low motivation, while top-ranked facilitators included availability of a wider array of NPMs and a team-based approach that included follow-up. Top-ranked provider-reported barriers included inability to promote NPMs once opioid therapy was started and patient skepticism about efficacy of NPMs, while top-ranked facilitators included promotion of a facility-wide treatment philosophy and increased patient knowledge about risks and benefits of NPMs.

Conclusions: In a multi-stakeholder qualitative study using NGT, we found a diverse array of potentially modifiable barriers and facilitators to NPM uptake that may serve as important targets for program development.

Keywords: Chronic pain; Non-pharmacological treatment; Qualitative research.

PubMed Disclaimer

References

    1. Committee on Advancing Pain Research Care, Institute of Medicine: Relieving pain in America: A blueprint for transforming prevention, care, education, and research. Washington: National Academies Press; 2011. - PubMed
    1. Mafi JN, McCarthy EP, Davis RB, Landon BE. Worsening trends in the management and treatment of back pain. JAMA Intern Med. 2013;173:1573–81. doi: 10.1001/jamainternmed.2013.8992. - DOI - PMC - PubMed
    1. Chou R, Fanciullo GJ, Fine PG, Adler JA, Ballantyne JC, Davies P, Donovan MI, Fishbain DA, Foley KM, Fudin J, et al. Clinical guidelines for the use of chronic opioid therapy in chronic noncancer pain. J Pain. 2009;10:113–30. doi: 10.1016/j.jpain.2008.10.008. - DOI - PMC - PubMed
    1. The Management for Opioid Therapy for Chronic Pain Working Group: VA/DoD Clinical Practice Guideline for Management of Opioid Therapy for Chronic Pain. 2.0 edn. Washington: Office of Quality and Performance; 2010.
    1. DeBar L, Kindler L, Keefe F, Green C, Smith D, Deyo R, Ames K, Feldstein A. A primary care-based interdisciplinary team approach to the treatment of chronic pain utilizing a pragmatic clinical trials framework. Transl Behav Med. 2012;2:523–30. doi: 10.1007/s13142-012-0163-2. - DOI - PMC - PubMed

Publication types