Deflecting Before Prescribing: Negotiating About Opioids and Chronic Pain in Primary Care

Area of Science:

• Medical communication
• Pain management
• Health services research

Background:

• Opioid therapy for chronic pain involves complex patient-physician communication.
• Understanding communication dynamics is crucial for effective pain management and patient satisfaction.

Purpose of the Study:

• To examine opioid-related treatment negotiations in primary care visits for chronic pain.
• To identify physician "deflection" practices and communication styles.
• To explore associations between communication patterns and patient/physician visit experience.

Main Methods:

• Video-recorded 86 primary care visits of patients on chronic opioids.
• Utilized conversation analysis to identify patient requests and physician deflection tactics.
• Employed generalized linear mixed models to analyze associations between communication and experience.

Main Results:

• Most patients (96%) used indirect requests for better pain control.
• Physicians averaged 67 "deflection" instances before treatment recommendations.
• Increased deflection frequency was linked to worse patient and physician visit experiences.

Conclusions:

• Physicians engage in extensive communication work before making opioid treatment recommendations.
• Specific physician communication styles and deflection practices impact visit experience.
• Analyzing negotiation practices may reveal strategies to improve opioid-related discussions.