Barriers and facilitators to use of non-pharmacological treatments in chronic pain.
BACKGROUND
Consensus guidelines recommend multi-modal chronic pain treatment with increased uptake of non-pharmacological pain treatment modalities (NPMs). We aimed to identify the barriers and facilitators to uptake of evidence-based NPMs from the perspectives of patients, nurses and primary care providers (PCPs).


METHODS
We convened eight separate groups and engaged each in a Nominal Group Technique (NGT) in which participants: (1) created an individual list of barriers (and, in a subsequent round, facilitators) to uptake of NPMs; (2) compiled a group list from the individual lists; and (3) anonymously voted on the top three most important barriers and facilitators. In a separate process, research staff reviewed each group's responses and categorized them based on staff consensus.


RESULTS
Overall, 26 patients (14 women) with chronic pain participated; their mean age was 55. Overall, 14 nurses and 12 PCPs participated. Seven healthcare professionals were men and 19 were women; the mean age was 45. We categorized barriers and facilitators as related to access, patient-provider interaction, treatment beliefs and support. Top-ranked patient-reported barriers included high cost, transportation problems and low motivation, while top-ranked facilitators included availability of a wider array of NPMs and a team-based approach that included follow-up. Top-ranked provider-reported barriers included inability to promote NPMs once opioid therapy was started and patient skepticism about efficacy of NPMs, while top-ranked facilitators included promotion of a facility-wide treatment philosophy and increased patient knowledge about risks and benefits of NPMs.


CONCLUSIONS
In a multi-stakeholder qualitative study using NGT, we found a diverse array of potentially modifiable barriers and facilitators to NPM uptake that may serve as important targets for program development.
West Haven VA Medical Center, VA Connecticut Healthcare System, Mail Stop 151B 950 Campbell Avenue, West Haven, CT, 06516, USA. william.becker@yale.edu.|Yale University School of Medicine, New Haven, CT, USA. william.becker@yale.edu.
William C
WC
Becker
Walter Reed National Military Medical Center, Bethesda, MD, USA.
Lindsey
L
Dorflinger
West Haven VA Medical Center, VA Connecticut Healthcare System, Mail Stop 151B 950 Campbell Avenue, West Haven, CT, 06516, USA.|Yale University School of Medicine, New Haven, CT, USA.
Sara N
SN
Edmond
University of Maryland School of Medicine, Baltimore, MD, USA.
Leila
L
Islam
West Haven VA Medical Center, VA Connecticut Healthcare System, Mail Stop 151B 950 Campbell Avenue, West Haven, CT, 06516, USA.|Yale University School of Medicine, New Haven, CT, USA.
Alicia A
AA
Heapy
West Haven VA Medical Center, VA Connecticut Healthcare System, Mail Stop 151B 950 Campbell Avenue, West Haven, CT, 06516, USA.|Yale University School of Medicine, New Haven, CT, USA.
Liana
L
Fraenkel
D000368:Aged; D001294:Attitude to Health; D059350:Chronic Pain / Q000628:therapy*; D032921:Consensus; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D059408:Pain Management / Q000379:methods*; D016730:Program Development; D036301:Qualitative Research
Chronic pain; Non-pharmacological treatment; Qualitative research