title: Voices that may not otherwise be heard: a qualitative exploration into the perspectives of primary care patients living with chronic pain.
abstract: BACKGROUND
  Although psychometrically sound pain assessment tools are available, there is a paucity of research that comprehensively defines chronic pain from the perspective of patients. The purpose of this study was to examine the utility of a combination of qualitative methods (Photovoice, one-on-one interviews, and focus groups) in examining the daily experiences of primary care patients living with chronic pain.
  
  
  METHODS
  A sample of English-speaking primary care patients aged 30 years or older, who had been prescribed an opioid for long-term, noncancer pain management, participated in the study. Each patient took photographs that best reflected both his/her experiences with chronic pain and what he/she would like his/her life to be without chronic pain.
  
  
  RESULTS
  Patients submitted an average of 20.2±3.1 photographs (range =8-27 photographs). Analysis of one-on-one interviews illuminated five dominant themes: daily need for multiple medications, including opioids; difficulties climbing a flight of stairs; struggling to get out of bed in the morning; extreme challenges with participating in day-to-day life activities; and experiencing feelings of hopelessness and helplessness on a regular basis. Seven themes emerged from the focus groups: undesired effects/burdens of medications, loss of/striving for independence, effect on social interactions/relationships, pain effect on activities of daily living, constant search for convenience/a better situation, interactions with physicians, and frustration/depression with pain.
  
  
  CONCLUSIONS
  The qualitative methods employed in this study provide deep insight into perceptions and experiences of patients living with chronic pain that is vital for informing future clinical interventions.
authors.affiliation: Department of Family Medicine, the Ohio State University, Columbus, OH, USA.
authors.forename: Lorraine S
authors.initials: LS
authors.lastname: Wallace
authors.affiliation: Department of Family Medicine, the Ohio State University, Columbus, OH, USA.
authors.forename: Randell K
authors.initials: RK
authors.lastname: Wexler
authors.affiliation: Department of Family Medicine, the Ohio State University, Columbus, OH, USA.
authors.forename: Leon
authors.initials: L
authors.lastname: McDougle
authors.affiliation: Department of Family Medicine, the Ohio State University, Columbus, OH, USA.
authors.forename: W Frederick
authors.initials: WF
authors.lastname: Miser
authors.affiliation: Health Policy, Purdue Pharma L.P., Stamford, CT, USA ; Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, MA, USA.
authors.forename: J David
authors.initials: JD
authors.lastname: Haddox
keywords: Photovoice; opioid; qualitative research