Table 3.

Physician-reported barriers and needs to improve pain management

Categories	N	Representative Quotes
Access to Allied Health Professionals and Non-Pharmacological Treatment	15	“The lack of coverage for allied health (e.g., psychotherapy, physiotherapy, massage therapy) creates significant barriers to other non-medication modalities.” “[The] biggest barrier is lack of access/financial support for patients requiring physical and psychological treatments”
eHealth Platform with Integrative Features	10	“We don’t have capability for patient questionnaires/forms to be electronically entered into our EMR. Currently, they [patients] have to fill the form out on paper and then the form has to be scanned into our EMR and the data has to be manually entered in order for it to be tracked. Very time consuming and thus we tend not to use the forms very much as not easy to track data generated from the forms.” “I’d like app integration that asks for pain scores and complications post procedure rather than waiting 2 weeks to find out their pain was worse for 72 h after procedure or they went to the ED [Emergency Department] instead of calling me.”
Access to Pain Specialists and Multidisciplinary Pain Clinics	9	“The main barrier in BC is the complete lack of multidisciplinary chronic pain programs. There is a hodgepodge of programs that offer limited options (and often just short-term) for patients and their primary care providers.” “Lack of inter-professional (ie Team) supports in rural areas is a real challenge.”
Improved Support for Opioid Prescribing and Management	7	“I regard the restrictions placed by CPSBC [College of physicians and Surgeons of BC] – with inevitable audits for prescribing opioids – as significant deterrents to assuming care of patients with chronic pain on opioids.” “Over the past 5 years, the prescribing of opiates has been questioned/advised against to the extent that I feel that I am a bad doctor to prescribe them for patients whose pain is not controlled with prescription nsaids (if they can take them) and acetaminophen. The culture of the [CPSBC] and in the medical community is now that one is an “outlier” if one prescribes them for patients. I struggle with this, as I know that there are some situations that patients need narcotics, and untreated chronic pain has mental health consequences.”
Improved Links to Community Resources to Community Resources	4	“What is lacking for me is access to community resources to dovetail the patient to when they’re discharged from hospital.” “A high-quality list of community resources for different types of pain would be very useful as part of a technological option. (e.g. could look with a patient on a map and filter types of supports).”
Improved Remuneration for Physician Time	4	“In primary care, the fee for service model runs on a 7–10 min appointment expectation, which does not allow for good chronic pain care beyond basic interventions.” “Physicians need to be taught how to manage chronic pain - and remunerated adequately for it, as it is very time consuming and often involves challenging conversations and patients who have suffered and do not trust the system, making it more challenging to connect with them.”
Improved Pain Education for Physicians and General Public	4	“Management of NCCP [Noncancerous chronic pain] is not taught in med school.” “I believe more public education is needed to change the broader societal understanding of pain and expectation of the process and management.”
Patient Access to Internet/Technology	4	“My main barriers: low-income patients who have limited/no access to technology…” “Some patients are not comfortable or equipped to work online or may have poor internet connections”

Note. Themes were extracted from responses to an open-ended question: “If there is anything else you would like us to know, please share your comments below (e.g., other barriers you may experience with pain management and technology).” N = 43