Is It “True” Pain? Pain Treatment Discharge Planning for Seriously Injured Patients

Background: The United States is experi­encing an opioid overdose crisis accounting for as many as 130 deaths per day. As a result, health care providers are increas­ingly aware that prescribed opioids can be misused and diverted. Prescription of pain medication, including opioids, can be in­fluenced by how health care providers per­ceive the trustworthiness of their patients. These perceptions hinge on a multiplicity of characteristics that can include a patient’s race, ethnicity, gender, age, and present­ing health condition or injury. The purpose of this study was to identify how trauma care providers evaluate and plan hospital discharge pain treatment for patients who survive serious injuries. Methods: Using a semi-structured guide from November 2018 to January 2019, we interviewed 12 providers (physicians, nurse practitioners, physician assistants) who pre­scribe discharge pain treatment for injured patients at a trauma center in Philadelphia, PA. We used thematic analysis to interpret these data. Results: Participants identified the impor­tance of determining “true” pain, which was the overarching theme that emerged in analysis. Subthemes included perceptions of the influence of reliable methods for pain assessment, the trustworthiness of their patient population, and the consequences of not getting it right. Conclusions: Trauma care providers de­scribed a range of factors, beyond patient-elicited pain reports, in order to interpret their patients’ analgesic needs. These included consideration of both the risks of under treatment and unnecessary suffering, and overtreatment and contribution to opi­oid overdoses. Ethn Dis. 2021;31(1):139- 148; doi:10.18865/ed.31.1.139