Chronic pain management in a reservation border town.

摘要

Pain is a growing national public health problem that contributes to spiraling health care costs and significant societal burden in the United States. It is the most common reason for seeking health care services, and is the leading cause of disability (CDC, 2008). Inadequately treated pain has profound social, psychological, economic, and physiological consequences for patients, their families, and society (American Pain Society, 2009).;A community-based participatory research (CBPR) approach was used for this project to develop a knowledge base about issues associated with chronic pain and its treatment among Native American people in Winslow, AZ. Mixed methods (qualitative and quantitative) were used to gain insight into the local factors that contribute to the self-management and treatment of chronic pain. Two sources of data were used for this assessment. Data were collected from people living within the community and from health care providers working with the community. Patients with chronic pain were interviewed to explore patient factors that influence pain management. Healthcare providers participated in a survey to explore physician factors that influence pain management at WIHCC and to compare the survey results to the results on the same survey of Texas providers as reported by Weinstein, et al (2000). Qualitative content analysis was used for the interview data with patients and quantitative analytical strategies were used with the provider data.;The results of the provider survey indicated that there are negative psychological traits toward patients with chronic pain such as authoritarianism, intolerance of ambiguity, reliance on technology, and locus of control which are factors that are known to negatively influence pain care (Weinstein et al, 2000). Lack of knowledge regarding pain and pain management along with perceptions and fears related to drug regulatory agencies were additional factors that were found, constituting additional barriers. Patient participants were generally dissatisfied with the pain care practices at Winslow Indian Health. Patient reported treatment goals that included relief of pain, improved quality of life, the ability to return to work, the ability to perform household chores, and the ability to participate in more physical leisure activities.;This results of this practice inquiry indicate there is a disconnect between patient and provider views and expectations around pain treatment and the need for further studies to determine the best ways to address chronic pain at the local level. The development of a pain management program is recommended to address the unmet needs of patients with chronic pain. Education in pain management is recommended for healthcare providers, including information regarding the benefits of non-pharmacologic therapies for pain management. The practice inquiry also supports the need for new policies at the local, tribal, and national levels to address pain as a growing public health issue.