Table 2.

Barriers and Facilitators to Implementing Office-based Pain Management

Themes	Subthemes	Examples
Physician factors	Pain assessment Expertise in pain management Expertise in POA* Co-existing disorders Interest in pain management Aberrant behaviors Prescribing opioid analgesics Opioid agreements† Continuity of care†	Absence of physiological measures of pain intensity Absence of formal training in pain management Difficulty broaching topic of medication abuse Difficulty managing co-occurring psychiatric conditions Absence of interest in treating pain patients Patients’ exclusive focus on opioid analgesics Reluctance to “over-prescribe” opioids for pain relief Specifying expectations about patient behaviors Enhanced patient compliance
Physicians’ perceptions of patient factors	Physicians’ response Attitudes to prescription opioids Cost Motivation	Physicians not listening to patients’ pain reports Concern about addiction potential Concern about covering pain management costs Patient diversion of prescription opioid medication
Logistical and systemic factors	Pain management referrals Addiction referrals Diagnostic workup Ancillary staff Time Insurance coverage	Lack of appropriate pain management referrals Low patient compliance with referrals Absence of sufficient diagnostic data Lack of confidence in ancillary staff’s skills Time spent completing paperwork Concern about pain management reimbursement

^*POA = Pain and opioid addiction.

^†Facilitators.