The design of a theory-based intervention to improve medication adherence in chronic pain patients

Abstract

Objective: Non-adherence to pain medication is common in chronic pain patients and may result in unfavorable treatment outcomes. Interventions to improve adherence behavior often fail to significantly change medication use. In this report, we describe the application of a theoretical psychological model of behavior change in order to design an intervention to improve medication adherence in chronic pain patients.

Methods: This study applies the Behavior Change Wheel framework and the Behavior Change Techniques Taxonomy to design a theory-based intervention to improve pain medication use. Available literature was used to extract determinants of adherence in chronic pain patients.

Results: Selected target behaviors to improve medication adherence are: share agreement on follow up policy, monitor medication adherence, provide patient education routinely, discuss attitudes and concerns towards pain medication, develop medication taking habits and use medication reminders. The intervention consists of three components in which relevant behavior change techniques are applied: (1) changes in the electronic patient data management systems to enable medical staff to apply target behaviors; (2) bi-annual education of medical staff to commit the team to the proposed intervention and provide feedback; (3) routine and mandatory education of chronic pain patients following prescription of pain medication.

Conclusions: To improve medication adherence in chronic pain patients, most interventions should be focused on providers of pain therapy. Prescribing chronic pain medication should be seen as part of a larger treatment regimen including adequate follow-up, adherence monitoring and patient education during the course of treatment.

Keywords:

• Chronic pain
• medication adherence
• pain therapy
• medication compliance
• intervention

Transparency

Declaration of funding

This study was funded by departmental funds of the Center for Pain Medicine of the Erasmus MC and the department of Anesthesiology, Intensive Care and Pain Medicine of the St Antonius Hospital.

Author contributions: L.T. performed the literature review, chose and applied the stepwise approach to design an intervention to improve medication adherence and drafted the paper. D.L.S., as a psychologist, critically revised the manuscript for the intellectual content. F.J.P.M.H., the project leader, supervised the project and revised the manuscript. All authors approved the final content of the manuscript.

Declaration of financial/other relationships

L.T., D.L.S. and F.J.P.M.H. have disclosed that they have no significant relationships with or financial interests in any commercial companies related to this study or article.

CMRO peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Acknowledgements

We are grateful for the help of Eric van Dongen, Sjoerd van Egeraat and Willem-Jan Hofste for taking part in the selection process of target behaviors to change adherence.