“That Pain Is Genuine to Them”: Provider Perspectives on Chronic Pain in University Student Populations

We explored provider attitudes about and experiences in chronic pain management for university student populations. Our central question was: "What do providers at a large university campus health care center experience in the process of offering pain management services?" We explored instrumental, behavioral, emotional, and attitudinal dimensions of our participants' experiences using a qualitative case study approach. Data were gathered through semi-structured interviews with 10 health care providers at the student health center for a large research university in Florida. Interviews captured providers' background and experiences in providing pain management to student patients with diverse needs. We used grounded theory techniques for data analysis (i.e., collaborative content analysis with open coding). Data reflect differences in perceptions of chronic pain prevalence and palliation best practices. We identified five themes: different perceptions of chronic pain prevalence, awareness of painful conditions, palliation as a contested process, importance of communication, and multidimensional perspectives. Responses varied by training, specialization, experience, and sociodemographics. Our findings mirror the broader literature on pain management. We outline priorities for further research in university health care settings, and suggest participatory strategies for translating associated findings into targeted plans for clinical care improvement. Keywords: Pain Management, Adolescents, Young Adults, Health Care, University Clinics, Medical Providers, Case Study Chronic pain management remains a frequently studied topic in health services research, as well as a constant source of change and reform in clinical care practices. Yet these efforts are often restricted to health care settings that capture only specific portions of the total population that may experience persistent pain. University students represent one population whose pain management needs and outcomes are not yet documented in the literature. Gaps in the literature are particularly large for students who receive their health care on campus. Understanding these dynamics requires gathering perspectives from both campus health service users and the clinical providers who care for them. Extant literature suggests that differences in provider perception of pain prevalence and severity as well as appropriate clinical responses may limit the number and scope of pain management services delivered in a given health care setting, especially if providers work one-on-one rather than in teams. These differences can stem from variation in academic and professional training (Duke et al., 2013), disparities in access to health care resources and technologies (McGreary, McGreary, & Gatchel, 2012), limited scientific understanding of different pain types and pathways (Smith, Torrance, & Johnson, 2012), unconscious bias about people from different social backgrounds (Wandner et al., 2014), and/or diversity in how people from different cultures communicate about pain (Campbell & Edwards, 2012). Students on university campuses are often a highly diverse population, especially at large schools enrolling learners from multiple countries and cultures. Studying chronic pain management services at the campus health center for a large research university thus offers opportunities both to understand overall successes and challenges in palliation for student populations, and to illuminate potential disparities in processes and outcomes for students with different backgrounds and circumstances. Conducting research with student users of health services also presents unique challenges for confidentiality and participant protection, in addition to the recruitment challenges implied previously. We thus saw value in beginning with providers to understand their perceptions of the magnitude and scope of chronic pain within their service population, and assessing their attitudes about how to manage these health challenges. …