title: A qualitative study of veterans on long-term opioid analgesics: barriers and facilitators to multimodality pain management.
abstract: OBJECTIVE
  The aim of this study was to examine barriers and facilitators to multimodality chronic pain care among veterans on high-dose opioid analgesics for chronic non-cancer pain.
  
  
  METHODS
  A Veterans Health Administration clinic in San Antonio.
  
  
  METHODS
  Twenty-five veterans taking at least 50 mg morphine equivalent daily oral opioid doses for more than 6 months.
  
  
  METHODS
  Three semi-structured focus groups, each with seven to nine veterans. Interview guide addressed: chronic pain effects on quality of life, attitudes/experiences with multimodality pain care, social support, and interest in peer support. In an iterative process using grounded theory, three reviewers reviewed de-identified transcripts for themes. The theory of planned behavior (TPB) framework was used to classify barriers and facilitators to multimodal pain management.
  
  
  RESULTS
  The 25 participants had a mean age of 54 years (39-70); 32% were women and 24% non-white. The three TPB dimensions (attitudes, social norms, and perceived behavioral control) were reflected in emergent themes: 1) uncontrollable impact of pain in all aspects of life; 2) reliance on opioids and challenges in obtaining these drugs despite ambivalence about benefits; 3) poor access to and beliefs about non-pharmacologic therapies; 4) frustrations with Department of Veterans Affairs health care; and 5) poor social support and isolation reflected by limited interest in peer support.
  
  
  CONCLUSIONS
  Veterans with chronic pain on long-term opioids hold pervasive attitudes that prevent them from using multimodality pain management options, lack social support and social norms for non-opioid-based pain treatment options, and have poor perceived control due to poor access to multimodality care.
authors.affiliation: Research to Advance Community Health Center (ReACH Center), University of Texas Health Science Center at San Antonio (UTHSCSA), San Antonio, Texas, USA; Veterans Evidence-based Research Dissemination and Implementation Center (VERDICT), South Texas Veterans Health Care System, San Antonio, Texas, USA.
authors.forename: Maureen J
authors.initials: MJ
authors.lastname: Simmonds
authors.forename: Erin P
authors.initials: EP
authors.lastname: Finley
authors.forename: Shruthi
authors.initials: S
authors.lastname: Vale
authors.forename: Mary Jo
authors.initials: MJ
authors.lastname: Pugh
authors.forename: Barbara J
authors.initials: BJ
authors.lastname: Turner
mesh_terms: D000328:Adult; D000368:Aged; D000701:Analgesics, Opioid / Q000627:therapeutic use*; D059350:Chronic Pain / Q000188:drug therapy*; D003131:Combined Modality Therapy; D005260:Female; D017144:Focus Groups; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008297:Male; D008875:Middle Aged; D059408:Pain Management / Q000379:methods*; D036301:Qualitative Research; D014481:United States; D014728:Veterans / Q000523:psychology*; D058014:Veterans Health
chemical_list: D000701:Analgesics, Opioid
keywords: Alternative Therapies; Chronic Pain; Narcotics; Veterans