• Karleen F Giannitrapani, Sangeeta C Ahluwalia, Matthew McCaa, Maura Pisciotta, Steven Dobscha, and Karl A Lorenz.
• Center for Innovation to Implementation, VA Palo Alto Health Care System, Menlo Park, California, USA.
• Pain Med. 2018 Jul 1; 19 (7): 1357-1364.

BackgroundOpioid prescribing for chronic pain, including the potential for over-reliance and misuse, is a public health concern.ObjectiveIn the context of Veterans Administration (VA) primary care team-based pain management, we aimed to understand providers' perceptions of barriers to reducing opioid use and improving the use of nonpharmacologic pain management therapies (NPTs) for chronic pain.DesignA semistructured interview elucidated provider experiences with assessing and managing pain. Emergent themes were mapped to known dimensions of VA primary care access.SubjectsInformants included 60 primary care providers, registered nurses, licensed practical nurses, clerks, psychologists, and social workers at two VA Medical Centers.MethodsNine multidisciplinary focus groups.ResultsProvider perceptions of barriers to reducing opioids and improving use of NPTs for patients with chronic pain clustered around availability and access. Barriers to NPT access included the following subthemes: geographical (patient distance from service), financial (out-of-pocket cost to patient), temporal (treatment time delays), cultural (belief that NPTs increased provider workload, perception of insufficient training on NPTs, perceptions of patient resistance to change, confrontation avoidance, and insufficient leadership support), and digital (measure used for pain assessment, older patients hesitant to use technology, providers overwhelmed by information).ConclusionsDecreasing reliance on opioids for chronic pain requires a commitment to local availability and provider-facing strategies that increase efficacy in prescribing NPTs. Policies and interventions for decreasing utilization of opioids and increasing use of NPTs should comprehensively consider access barriers.2017 American Academy of Pain Medicine. This work is written by US Government employees and is in the public domain in the US.

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