Experiences and Expectations: findings from focus groups of older people attending pain clinics.

1. Experiences and Expectations: findings from focus groups of older people attending pain clinics. On behalf of the EOPIC Team (Dr Derek Jones1, Professor Denis Martin2, Dr Pat Schofield3, Dr Paul McNamee4, Geraldine Anthony 5, Dr Amanda Clarke1, Professor Blair Smith5) 1 Northumbria University, 2 Teesside University Institute of Health & Social Care, 3University of Greenwich, 4 Aberdeen University Health Economics Research Unit, 5University of Dundee. EOPIC Engaging Older People and their carers to develop Interventions for the self-management of Chronic pain Background Methods The care pathway to the pain clinic was typically a complex one and often represented the end of a long journey following diagnosis of a primary condition. A second emerging theme relates to the degree to which participants would be willing to accept frequent interventions with short lived benefits because of the pain relief obtained. Lack of easy access to pain clinics (in terms of frequency of appointments and geographical location ) was highlighted as a negative issue in relation to current services and a barrier to future developments. Views on pharmacological interventions were mixed with some positive experiences reported but also some strong concerns about polypharmacy and opiods (referred to as ‘hill-billy heroin’ by one participant). Chronic pain is a major health condition associated with ageing, whose management (pharmacological and non-pharmacological) is generally unsatisfactory 1. Pain clinics have an important role to play in pain management and vary in the services they provide; from anaesthetist led biomedical interventions to multidisciplinary teams encompassing biopsychosocial approaches . Research to date has examined the characteristics of older people attending pain clinics and how they do or do not differ from patients of working age2,3. In comparison, the experiences of older people using those clinics have been subject to less scrutiny. References 1 Breivik H, Collett B, Ventafridda V, Cohen R, Gallacher D: Survey of chronic pain in Europe: prevalence, impact on daily life, and treatment. Eur Jnl of Pain. 10, 287-233 (2006). 2 Leong, I., Farrell, M., Helme, R., & Gibson, S: The relationship between medical comorbidity and self-rated pain, mood disturbance, and function in older people with chronic pain. Journals Of Gerontology Series A: Biological Sciences & Medical Sciences, 62A(5), 550-555 (2007). 3 Mailis-Gagnon A, Nicholson K, Yegneswaran B, Zurowski M: Pain characteristics of adults 65 years of age and older referred to a tertiary care pain clinic. Pain Res Manag. 13(5): 389–394 (2008). 3 focus groups were undertaken in NE Scotland (n=20) and 3 in NE England (n=20). Participants included males and females and ranged in age from 68-87; diagnoses included conditions with nocicpetive and/or neuropathic pain as a feature. All participants were recruited from local pain clinics. Groups were audio taped and group co-facilitators made contemporaneous notes. Data from these two sources were subject to descriptive content analysis and thematic analysis (this iterative process is still in progress). The topic schedule for the focus groups addressed the following issues: referral to pain clinic, prior expectations and actual experience of the pain clinic, advice they would give to others referred to a pain clinic, experience of participation in the focus group. Conclusions Older people attending pain clinics take a pragmatic approach to pain management and are willing to trial proposed interventions despite some concerns about pharmacological approaches. Access to pain clinics in terms of early referral, frequency of appointments, and geographical location is worthy of further investigation. Participation in the focus groups was valued and suggests opportunities for peer support should be developed. Aims Findings To explore the treatment expectations and experiences of older adults attending pain clinics. Analysis to date indicates a diversity of expectations and experiences; the only shared experience emerging strongly has been satisfaction gained from participating in the focus group (having the opportunity to hear the story of others in similar circumstances) and an endorsement of pain clinics as a something ‘worth a try’. This study was funded by the LLHW initiative University of Aberdeen University of Dundee Northumbria University