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Table 1 Chronic Pain Patients as Complex Patients: Supplementary Quotes

From: The mismeasurement of complexity: provider narratives of patients with complex needs in primary care settings

One of my most complex patients would be an elderly woman who is one of my chronic pain clients. She’s got multiple concerns every time she comes in. She’s got bowel troubles, she’s got blood pressure issues, she’s got cholesterol problems. She’s got lots of chronic pain, and it’s in her neck, in her shoulder, in her hip. She’s got osteoporosis. She’s got eye problems. She’s really attached to me, so it’s really difficult to also get her engaged with other sources here. She comes to me and she likes to tell me about all her different problems and then it means getting her sorted to all the different specialists that she might need. She’ll often go to the specialist and then still not be satisfied with what they had to say and want a second opinion. I find that can be quite complicated (Interview 15, nurse practitioner).
We have a couple of patients coming through actually, who have had chronic pain, fibromyalgia-type diagnosis, and they’ve also had gastric bypass surgery, and then there’s also some previous injuries or surgeries on knees, or whatever it might be. Those are a couple of our complex patients coming through, and they have a difficulty at times, being heard, I think, and being understood. The complexity of the gastric bypass, and how they absorb medications and things like that, is something that they feel that people don’t quite understand, for them. Because they feel once they’ve had the gastric bypass surgery, that there’s no … absorption of the medication is completely different, and it might travel through their system faster or slower, or whatever it might be, and they feel that they’re not being heard in terms of they actually have legitimate pain (Interview 20, nurse).
From a standpoint of true complexity, I had a young woman as an example, a young mother, who developed what’s called chronic regional pain syndrome, used to be RSD, so what I’ve come to think of as a substantial wiring problem in the pain system (Interview 22, Family Physician).
Complex would be a patient … we have a patient that has cancer. I think it’s colon cancer. He is a smoker. He has hypertension and diabetes. He’s obese. He has a lot of pain. So that would be a complex patient just because he’s on chemo and then half the time when he’s walking here he’s in so much pain. He has trouble walking from one end to the other. Like him, it would be trying to make him comfortable and stuff but then his significant other is … she’s an alcoholic and I don’t know if she takes drugs or not but that’s complex too. The whole situation, like you’ve got to look at the patient plus whatever happens with the patient, like things that happen around the patient, so significant other and other stressors (Interview 24, nurse).