title: "Is there any way I can get something for my pain?" Patient strategies for requesting analgesics.
abstract: OBJECTIVE
  We examined the direct and indirect means by which patients express a desire for analgesic medication.
  
  
  METHODS
  Back pain patients presenting to an academic ED were invited to participate in a study of patient-provider communication. Audio-recorded encounters were transcribed verbatim and transcripts analyzed using a qualitative approach based on conversation analysis.
  
  
  RESULTS
  Requests for analgesics were documented in 15 out of 74 interactions (20%). We identified three basic patterns: direct requests, in which the patient explicitly asked for medication; indirect requests, in which the patient hinted at a desire for medication but did not ask for it outright; and no request, in which the provider discussed a prescription without the patient requesting it.
  
  
  CONCLUSIONS
  Most patients did not request analgesics. When they did so, they utilized strategies of mitigation, indirection, and deference that presented themselves as deserving patients while upholding the physician's autonomy.
  
  
  CONCLUSIONS
  Patients come to the clinical encounter with a variety of expectations, of which a desire for an analgesic may be only part of the picture. Rather than focusing on strategies for inuring providers to inappropriate patient requests, it may be useful to devote clinical resources to examining patients' priorities and expectations for treatment.
authors.affiliation: Department of Social Medicine, University of North Carolina at Chapel Hill, Chapel Hill, USA. Electronic address: mara.buchbinder@gmail.com.
authors.forename: Mara
authors.initials: M
authors.lastname: Buchbinder
authors.affiliation: Department of Health Behavior and Health Education, University of North Carolina at Chapel Hill, Chapel Hill, USA.
authors.forename: Rachel
authors.initials: R
authors.lastname: Wilbur
authors.affiliation: Departments of Anesthesiology and Emergency Medicine, University of North Carolina at Chapel Hill, Chapel Hill, USA.
authors.forename: Samuel
authors.initials: S
authors.lastname: McLean
authors.affiliation: Division of Pharmaceutical Outcomes and Policy, University of North Carolina at Chapel Hill, Chapel Hill, USA.
authors.forename: Betsy
authors.initials: B
authors.lastname: Sleath
mesh_terms: D000328:Adult; D000700:Analgesics / Q000627:therapeutic use*; D001416:Back Pain / Q000188:drug therapy*; D003142:Communication; D011307:Drug Prescriptions; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010817:Physician-Patient Relations; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D036301:Qualitative Research; D012017:Referral and Consultation; D013637:Tape Recording
chemical_list: D000700:Analgesics
keywords: Medication; Pain; Patient-provider communication; Politeness theory