Drug Counselor Responses to Patients' Pain Reports: A Qualitative Investigation of Barriers and Facilitators to Treating Patients with Chronic Pain in Methadone Maintenance Treatment.
OBJECTIVE
To examine how drug counselors with no prior training in pain management respond to their patients' reports of chronic pain.
We conducted individual interviews with 30 drug counselors in methadone maintenance treatment. Interviews were audiotaped, transcribed, and systematically coded using the constant comparative method.


RESULTS
Participants identified counselor, patient, and logistical factors that serve as a barrier or facilitate their treatment of patients with chronic pain. Counselor barriers included lack of expertise in managing co-occurring chronic pain and opioid use disorder, complexity of patients' treatment needs, concerns about medication regimens, reliance on patient self-report, and absence of patient improvement. Counselor barriers facilitators included empathy, attending to small changes, and self-reflection. Counselors' perceptions of patient-related barriers included prior negative interactions with medical providers, diminished social roles, attenuated motivation, and negative attitudes toward opioid use disorder. Logistical barriers included lack of appropriate pain management referrals, limited counselor time, and attenuated treatment adherence; a logistical facilitator was consulting with medical providers.


CONCLUSIONS
Perceived barriers to treating patients with chronic noncancer pain are common among drug counselors. Addressing these barriers in drug counselor training and in methadone maintenance treatment programs may benefit both methadone-maintained patients with chronic pain and their providers.
Yale University School of Medicine Department of Psychiatry, New Haven, Connecticut, USA.|Pain Treatment Services, The APT Foundation, Inc., New Haven, Connecticut, USA.
Mark
M
Beitel
Yale University School of Medicine Department of Psychiatry, New Haven, Connecticut, USA.|Pain Treatment Services, The APT Foundation, Inc., New Haven, Connecticut, USA.
Lindsay
L
Oberleitner
Yale University School of Medicine Department of Psychiatry, New Haven, Connecticut, USA.
Marissa
M
Kahn
Yale University School of Medicine Department of Psychiatry, New Haven, Connecticut, USA.|VA Connecticut Healthcare System, West Haven, Connecticut, USA.
Robert D
RD
Kerns
Pain Treatment Services, The APT Foundation, Inc., New Haven, Connecticut, USA.
Christopher
C
Liong
Yale University School of Medicine Department of Psychiatry, New Haven, Connecticut, USA.|Pain Treatment Services, The APT Foundation, Inc., New Haven, Connecticut, USA.
Lynn M
LM
Madden
Pain Treatment Services, The APT Foundation, Inc., New Haven, Connecticut, USA.
Joel
J
Ginn
Yale University School of Medicine Department of Psychiatry, New Haven, Connecticut, USA.|Pain Treatment Services, The APT Foundation, Inc., New Haven, Connecticut, USA.
Declan T
DT
Barry
D000328:Adult; D000701:Analgesics, Opioid / Q000009:adverse effects / Q000627:therapeutic use*; D059350:Chronic Pain / Q000188:drug therapy*; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008297:Male; D008691:Methadone / Q000009:adverse effects / Q000627:therapeutic use*; D008875:Middle Aged; D009042:Motivation / Q000187:drug effects; D058850:Opiate Substitution Treatment; D009293:Opioid-Related Disorders; D059408:Pain Management
D000701:Analgesics, Opioid; D008691:Methadone
Counseling; Opioid-Related Disorders; Pain; Qualitative Research