Pain remains a major concern for medically hospitalized adults, and pain treatment is a focus of hospital quality reporting and improvement efforts. Pharmacologic treatment during hospitalization for acute pain and cancer pain rest on some evidence, but as many as 1 in 3 adult medical inpatients suffer from chronic pain. Little is known about chronic pain as it contributes to the patient experience during hospitalization. The aim of this qualitative study is to describe the beliefs, attitudes, and experiences of medically hospitalized adults with chronic pain.
The study included twenty Veterans, who were admitted to a Veterans Administration hospital with medical diagnoses between April and September, 2015. Veterans were eligible for interview if they had one or more chronic pain diagnoses, long term opioid use, or consistently elevated pain scores prior to admission. The research team conducted semi-structured interviews with Veterans during their hospitalization. A codebook was developed based on initial interviews and refined based on emergent themes.
Four important themes emerged from our study. First, although patients commonly reported satisfaction with their pain levels, they described a lack of physician-patient communication about chronic pain and its causes. Second, patients related social and functional losses due to chronic pain. Third, some patients did not connect their chronic pain condition to their hospitalization while others strongly connected chronic pain with the reason for hospitalization. Fourth, patients generally did not identify psychological treatment as pain treatment, although some related coping strategies with acceptance of their pain condition.
The patient beliefs, attitudes, and experiences revealed in this study may help inform efforts to improve inpatient pain treatment. Recent work in the ambulatory setting has emphasized the importance of rapport, conversations about pain, and focus on functional outcomes rather than numeric pain ratings in the treatment of chronic pain. A significant proportion of hospitalized patients have chronic pain; acute and chronic pain should be distinguished to facilitate appropriate treatment of each. Examination of the varied lived experiences of inpatients with pain remains an important line of inquiry as we develop strategies to better treat pain during hospitalization.