Chronic Pain: Patient Journey Mapping

As part of our aim of reducing opioid prescribing, the North Carolina Healthcare Foundation (NCHF) was curious to learn more about patients with chronic pain — what their journey is like through the healthcare system, what are the barriers to non-opioid therapies, and what are the opportunities for improvement. With funding from the North Carolina Division of Public Health Injury and Violence Prevention Branch, the foundation utilized patient mapping to elicit the unique experiences and perspectives of patients with chronic pain and of the providers who care for them.

The following journey maps were created to increase understanding of the interactions, thoughts, and challenges of the chronic pain patient and their providers.

Carolinas Health Innovation Institute Program Manager
NC Healthcare Foundation
919-677-4136
mward@ncha.org

Significant themes were exposed during the patient journey mapping sessions including:

Time + Effort

1. Patients reported spending a lot of time pursuing new options of care, waiting to receive or access services, and navigating complex systems of care. The amount of effort patients reported they expended to navigate the healthcare system and numerous provider settings appeared significant, compounding their physical and emotional challenges as a chronic pain patient.
2. Patients stated that they were sometimes “on their own” in pursuit of non-medical and sometime medical therapies shown in the literature as useful in addressing pain relief. Patients appeared incredibly resourceful in identifying and accessing services, even when costs or availability limited access. Patients reported relying on independent research (i.e. internet search, word-of-mouth) to identify potential options.
3. Providers shared concerns over lack of skills, knowledge, and confidence in providing services and support to chronic pain patients.

Effective Collaboration

4. Patients reported that communication and collaboration among providers appears disjointed, inefficient, and disruptive to the patient’s ability to develop and follow a safe and effective pain management plan.
5. Providers noted that other providers sometimes did not recognize or acknowledge non-medical therapies reported in the literature as useful therapies for chronic pain relief. Patients commented that some providers would not support non-medical therapies and often insisted that only one therapy at a time should be used to determine what would “work” for the patient. This approach was reported as contrary to patients who found multiple therapies at the same time were needed to experience pain relief.

Trust

6. Trust among patients and providers is key to establishing and following agreed upon plans of care and achieving individual and shared goals of care.
7. Patients reported frequent perceptions of stigma and bias from providers, especially when the plan of care included acceptable and approved use of opioids or other medications to obtain relief.

NCHF thanks the patients, patient advocates, caregivers, and providers that shared their story, experience, and journey with us.