Table 4.

Suggestions to optimize pain management in IBD care, reported by providers.

	Theme	Representative quote
Reported by providers only	Improve patient education and recalibrate patient expectations about pain management	“Educate first and foremost. Because a lot of patients don’t realize how harmful pain medications can be to their disease. But just because we don’t want them to take pain medication doesn’t mean that we want them to be in pain. We want to treat their disease and get rid of their pain but sometimes it’s not a quick fix.” [Nurse]
		“The biggest part is like education for patients, like understanding, making the correlation of like their disease process and where some medicines affect you long term. So I think education modules or any type of, you know, I mean, we’re so used to giving a pamphlet and I just think that gets kicked to the waste side. I think you got to think something electronically or something where patients have a better understanding of, um, what their disease is, because I can’t tell you how many times patients I still see don’t really understand their disease. You know, and I think it starts from there.” [Nurse Practitioner]
		“I think [it] would be helpful if it’s something that we can visualize, but also that’s something we can show to a patient when we see them. Like, you know, is, is there a scale to show them, like with these comorbid conditions. This is the risk that you accrue if you’re going into chronic narcotic use or frequent narcotic use and what that could really factor into your care long-term. So, I think visualizing it for a patient when you see them and when they’re asking you for this would be really helpful.” [Nurse Practitioner]
	Enhance provider education on opioid safety and safer alternatives to treat pain	“If we have [pain management information] on our website being an IBD center, [and] if other providers or patients from other sites are seeing this information, they understand how significant it is to avoid opioids and how they’re not hopeful and can actually be harmful in IBD.” [Nurse]
	Adopt a multidisciplinary approach to improve patient safety and care coordination	“The more we move towards a multi-disciplinary team, those things can be helpful. I think that IBD is very tied to colorectal surgery and vice versa because of the nature of what we do. I think that it could definitely benefit from having folks that are part of that integrative medicine plan. Having folks that are specializing in pain management, social workers, in addition to our dieticians and nutritionists. Having that multidisciplinary approach to patient care and maybe having even more dialogues or collaborations with those departments can only be helpful to the patient because they will have people to reach out to as opposed to just a referral generally to something that will have a point person for doing that.” [Physician]
		“Tracking medications [across centers] would be super helpful, because… some patients are really good about informing us when they’re on different types of medications. But others, we don’t hear from as much. And it’s pertinent to their disease process. That’s information that we want to know. So if it were something that were more readily available to us, I think it’d be helpful.” [Physician]
	Develop standardized approaches and tools to address pain	“I think… we all approach things very similarly as far as pain management, from a provider perspective. But, I think that it’s not documented anywhere, like this is the process. If a patient has X, Y and Z, what is the process map for treating them, and what is the goal for us and for our patients, and how do we get there? I don’t necessarily want to say a standardized approach, because it’s really difficult to standardize things with our patients as we talked about. But, if there was maybe just something, like a process that we could work through, like a tool. A tool between not just the provider but the patient and the provider, so we’re all on the same page.” [Nurse]
	Routinely implementing nonpharmacologic pain management strategies	“There are non-steroid types of things that we can use for abdominal cramping, abdominal bloating. IBGard, which has peppermint oil, can also be used as an adjunct. Also, things that are not typically considered a part of Western medicine, but Eastern medicine. For instance, acupuncture can be used, abdominal massages can used, referrals to Shirley Ryan for our physiatrist to actually see patients to manage other chronic related pain conditions associated with it.” [Physician]
	Shift toward a patient-centered or “whole person” care model	“When you’re treating an IBD patient, not only are you treating the disease… There’s a whole health maintenance aspect of it. There’s mental health. There’s all this cancer screening that we have to do. I think it’s part of the puzzle. Rather than just treating the IBD, if we were looking at things more holistically, it could be helpful. And then, it would help all these things that I’m like, ‘Well, I feel like we could do a better job with mental health. Or, I feel like we could do a better job of taking control if it was just more of the focus.’” [Nurse]
		“My sense is a lot of our patients would tell you they’re maybe not being treated for their pain… It would be interesting to see from the patient’s side, because maybe they think we undertreat pain. They probably do. I don’t know.” [Physician]
		“I think as an IBD provider, you look at the patient as a whole. I don’t know. This specific patient, I care because I care about him. That’s the bottom-line answer. I care because I care about him as a person and as a whole. Yes, opioid dependence definitely has an impact on the colitis. It can increase the risk for a toxic colon and so on and so forth, especially if you’re inflamed. Then we’ve talked all about that. Yeah, it impacts me that way. The reason that I wanted him to stop was it is for the colitis, but also for himself as a person.” [Physician]
	Consider potential challenges of changing provider behavior related to pain management	“I’m a bit cynical when it comes to resources because I’ve seen so many that are just not useful, websites and brochures and calculators, and phone numbers and support groups, and all this stuff. And I just don’t think any of those things replace the one-on-one conversation with a provider. I’m certainly willing to use those types of things, but I just don’t know how that looks… It’s hard for me to disconnect my own personal opinions from my patients. So, if I don’t think it would help me as a person, it’s hard for me to make that leap to advise my patients use it. If I think an app to track whatever is silly for me, why would I then go and tell my patients to use it? So, that’s a huge barrier for me. If I don’t personally buy into it, how do I then go and try to sell it to my patients? Part of it is me. Part of it is my own biases and my own opinions, and things like that. And maybe, the intervention needs to be for me rather than for my patients, but that’s sort of my own issue.” [Physician]

Abbreviation: IBD, inflammatory bowel disease.