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Therapeutic alliance impact on analgesic outcomes in a real-world clinical setting: an observational study
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  • Jordi Barrachina,
  • Cesar Margarit,
  • Blanca Andreu,
  • Thomas Zandonai,
  • Pura Ballester,
  • Javier Muriel,
  • Esperanza Cutillas,
  • Ana Peiro
Jordi Barrachina
Alicante Institute for Health and Biomedical Research
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Cesar Margarit
Hospital General Universitari d\'Alacant
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Blanca Andreu
Miguel Hernandez University of Elche
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Thomas Zandonai
Miguel Hernandez University of Elche
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Pura Ballester
Alicante Institute for Health and Biomedical Research
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Javier Muriel
Alicante Institute for Health and Biomedical Research
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Esperanza Cutillas
Miguel Hernandez University of Elche
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Ana Peiro
Alicante Institute for Health and Biomedical Research

Corresponding Author:[email protected]

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Abstract

Rationale aims and objectivesː A good therapeutic alliance or relationship is relevant for healthcare providers exposed to patients’ suffering, especially when patients and physicians may understand the painful experience differently. Our aim was to explore the impact of therapeutic alliance on analgesic outcomes in a real-world Pain Unit. Methodː A cross-sectional observational study was conducted on ambulatory patients (n=69) who use pain killers long-term during treatment of chronic non-cancer pain. Responses to a patient-doctor relationship questionnaire were correlated with levels of comprehension of prescription information provided during consultations. Socio-demographical and clinical information (pain level, quality of life and hospital use) were collected through the questionnaire, while pharmacology data (analgesic prescription, adverse events, and compliance) were obtained from electronic health records. Resultsː Patients were 75% middle-aged women, 72% retired, experiencing moderate pain on average, and under a high morphine equianalgesic dosage (95 ± 88 mg/day, mainly tapentadol or fentanyl). Patients with low therapeutic alliance showed a significantly higher pain intensity (80 ± 75 mm, p<0.01). In contrast, patients who reported high therapeutic alliance during the treatment reached a significant result of 35% lower pain intensity (d=1.079), 52% higher relief (d=0.675) and 48% better quality of life (d=0.638). Moreover, pain intensity was significantly lower when patients affirmed that, thanks to their doctors, they had gained new insights (d=0.574), felt better (d=0.756), or felt content with or benefit from the treatment of my doctor (d=0.826). A total of 65% of the full patient population reported the ability to manage their symptoms as well as better opioid knowledge, increasing their observed drug compliance by 15%. Conclusionsː Therapeutic alliance can be an effective strategy for impacting analgesic outcomes, as evidences in a real-world chronic pain clinical setting. More effort is necessary to improve communication strategies for pain management.