Advancing the Assessment and Management of Chronic Non-Oncological Pain: Qualitative Research with Albanian Primary Healthcare Providers

Abstract

This qualitative descriptive study explored the experiences, perceptions, and practices of primary healthcare providers—nurses and family doctors—in assessing and managing chronic non-oncological pain in Albania. Using purposive sampling, eight professionals (four nurses and four family doctors) from primary care centers in Vlore and Tirana participated in semi-structured interviews between January and February 2025. Data were analyzed thematically using Braun and Clarke’s six-step approach. Nine key themes emerged: assessment strategies, pain history and analysis, communication, management approaches, non-pharmacological methods, collaboration, education, barriers, and solutions. Nurses relied largely on patient-reported symptoms and observational cues, while family doctors employed diagnostic tools and considered psychosocial factors. Both groups emphasized interdisciplinary collaboration, patient education, and individualized care planning. Challenges included limited resources, patient non-compliance, and systemic barriers. Despite their differing roles, both nurses and doctors underscored the need for validated assessment tools and a holistic, team-based model to enhance patient outcomes. These findings support the DJO KRON project's objectives, which aim to improve chronic non-oncological pain care through education, innovation, and primary healthcare system reform. The study highlights the importance of integrated care models, ongoing professional development, and the adoption of multidisciplinary strategies to better address the complex needs of patients living with chronic pain.

Methods

A total of 4 primary care nurses and 4 family doctors were approached and agreed to participate in the study, with 2 nurses and 2 doctors from each of the cities of Vlore and Tirana. The average age of the nurse participants was 46 years (SD = 5.5), and all were female (N = 4; 100%). They had an average of 19.5 years of clinical experience (range: 14–25 years). The average age of the family doctor participants was 39.5 years (SD = 3.2), and, like the nurses, all were female (N = 4; 100%). Their average length of clinical practice was 12 years (range: 10–14 years). The healthcare providers indicated that they primarily serve older adults and individuals from low socio-economic backgrounds, typically treating 1 to 3 patients daily with chronic non-oncological pain. The interviews lasted between 30 and 60 minutes and were conducted at healthcare centers in Vlore and Tirana. The healthcare providers were given the opportunity to review the list of guided questions before the interviews, which were sent via email. The analysis revealed nine key themes related to chronic non-oncological pain for both nurses and family doctors, which included: identification & assessment, pain history & analysis, communication & engagement, pain management strategies, non-pharmacological methods, collaboration, education, barriers, and solutions & recommendations.

Results

As evidenced in our study, both nurses and family doctors emphasize the importance of patient selfreporting and clinical observations in identifying chronic non-oncological pain. Nurses rely heavily on cues such as patient posture, visible discomfort, and vital signs to assess pain, while also acknowledging the challenges posed by limited patient cooperation. These findings contrast with a systematic review on pain management by nurses, which found that the majority of nurses employed standardized pain assessment tools with patients, regardless of their ability to self-report. Current guidelines recommend that pain assessment and management by nurses be conducted as routinely as the monitoring of vital signs [17]. In our study, family doctors underscore the use of chronic pain criteria, diagnostic tools, and the consideration of psychosocial factors—such as depression—in pain assessment. They also highlight the challenge of patient reluctance to report pain, which can complicate diagnosis. These results are consistent with findings from other studies, which indicate that family doctors frequently take into account psychosocial factors like depression and anxiety, both of which can exacerbate the perception of pain [18].

Conclusions

The key findings from the perspectives of family doctors and primary healthcare nurses on chronic nononcological pain in Albania highlight several important themes. Family doctors use specific criteria and diagnostic tools, taking psychosocial factors into account, although patient reluctance to report pain remains a challenge. Nurses, in contrast, rely on patient self-reports, vital signs, and posture but face issues such as dishonesty and poor cooperation. Family doctors collect detailed lifestyle and socioeconomic data and emphasize follow-ups, while nurses focus on pain history, its impact, and prioritize empathy. In terms of pain management, doctors employ a mix of treatments, using opioids sparingly, whereas nurses concentrate on goal-setting and tracking treatment effectiveness. Both emphasize the need to collaborate with specialists, work in teams, tailor patient education, and navigate challenges such as non-compliance and healthcare system limitations. Both healthcare providers agree on the importance of education, multidisciplinary collaboration, and patient-centered care, although their methods and perspectives reflect their distinct roles within the healthcare system. They stress the value of a holistic, coordinated approach to chronic nononcological pain management, along with the use of validated assessment tools in clinical practice. In conclusion, it is emphasized that the future of chronic non-oncological pain management may benefit from a stronger interdisciplinary approach, continuous education, and technological innovations aimed at improving patient care and outcomes.

CONFLICT OF INTEREST

The authors declare no conflict of interest.

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