Chronic pain patients give different histories to different types of practitioners
Format Type
Plenary
Format Type
Paper
Start Date
13-1-2021 11:45 AM
End Date
13-1-2021 12:05 PM
Abstract
In previous research we found that chronic pain patients told different stories to medical students than they did to a physician who could prescribe medications. Their stories were more positive to the medical student and more angry, bitter, and dysfunctional to the physician. In this study we looked at the stories that patients told to their psychotherapist compared to those who could prescribe them medication. Stories told were analyzed in an iterative, comparative process using a constructivist, grounded theory approach as inspired by Charmaz. Two raters assessed overall level of positivity or negativity of emotional affect on a 5-point Likert scale (ranging from -2 to +2) with a third rater contributing to form an average in case of disagreement. We sought common themes in the reports that patients made to their practitioners. Forty-nine patients were included, of whom 19 were male and 30 were female. The setting consisted of medication assisted treatment programs based in a family medicine residency clinic in central, rural Maine. Negotiations with prescribers often involved requests for higher doses of opiates, benzodiazepines, and psychostimulants. Patients presented significantly more negative affect to those who could prescribe them medication. They put more emphasis on how poorly they were doing when speaking to prescribers while putting more emphasis on how well they were doing when speaking to counselors. Our findings underscore the patient-practitioner encounter as a negotiation in which a narrative is created to support a goal and helps us realize that no one person gets the full story.
Keywords
Prescribers, counsellors, narrative positioning, emotional coloration, opiate use disorder
Chronic pain patients give different histories to different types of practitioners
In previous research we found that chronic pain patients told different stories to medical students than they did to a physician who could prescribe medications. Their stories were more positive to the medical student and more angry, bitter, and dysfunctional to the physician. In this study we looked at the stories that patients told to their psychotherapist compared to those who could prescribe them medication. Stories told were analyzed in an iterative, comparative process using a constructivist, grounded theory approach as inspired by Charmaz. Two raters assessed overall level of positivity or negativity of emotional affect on a 5-point Likert scale (ranging from -2 to +2) with a third rater contributing to form an average in case of disagreement. We sought common themes in the reports that patients made to their practitioners. Forty-nine patients were included, of whom 19 were male and 30 were female. The setting consisted of medication assisted treatment programs based in a family medicine residency clinic in central, rural Maine. Negotiations with prescribers often involved requests for higher doses of opiates, benzodiazepines, and psychostimulants. Patients presented significantly more negative affect to those who could prescribe them medication. They put more emphasis on how poorly they were doing when speaking to prescribers while putting more emphasis on how well they were doing when speaking to counselors. Our findings underscore the patient-practitioner encounter as a negotiation in which a narrative is created to support a goal and helps us realize that no one person gets the full story.