Chronic pain leads to reduced quality of life for patients, and strains health systems worldwide. In the US and some other countries, the complexities of caring for chronic pain are exacerbated by individual and public health risks associated with commonly used opioid analgesics. To help understand and improve pain care, this article uses the data frame theory of sensemaking to explore how primary care clinicians in the US manage their patients with chronic noncancer pain. We conducted Critical Decision Method interviews with ten primary care clinicians about 30 individual patients with chronic pain. In these interviews, we identified several patients, social/environmental, and clinician factors that influence the frames clinicians use to assess their patients and determine a pain management plan. Findings suggest significant ambiguity and uncertainty in clinical pain management decision making. Therefore, interventions to improve pain care might focus on supporting sensemaking in the context of clinical evidence rather than attempting to provide clinicians with decontextualized and/or algorithm-based decision rules. Interventions might focus on delivering convenient and easily interpreted patient and social/environmental information in the context of clinical practice guidelines.

中文翻译：

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了解初级保健临床医生如何理解慢性疼痛

慢性疼痛导致患者生活质量下降，并使全球卫生系统紧张。在美国和其他一些国家，与常用阿片类镇痛药相关的个人和公共健康风险加剧了慢性疼痛护理的复杂性。为了帮助理解和改善疼痛护理，本文使用意义建构的数据框架理论来探索美国的初级保健临床医生如何管理慢性非癌性疼痛患者。我们对大约 30 名慢性疼痛患者的 10 名初级保健医生进行了关键决策方法访谈。在这些访谈中，我们确定了影响临床医生用来评估患者和确定疼痛管理计划的框架的几名患者、社会/环境和临床医生因素。研究结果表明，临床疼痛管理决策存在明显的模糊性和不确定性。因此，改善疼痛护理的干预措施可能侧重于支持临床证据背景下的意义建构，而不是试图为临床医生提供去上下文化和/或基于算法的决策规则。干预措施可能侧重于在临床实践指南的背景下提供方便且易于解释的患者和社会/环境信息。