Multicultural influences on pain medication attitudes and beliefs in patients with nonmalignant chronic pain syndromes.

The objective was to develop an integrated review of quantitative and qualitative research regarding the influence of patients' beliefs and attitudes toward pain medication prescribed for the treatment of nonmalignant chronic pain on use of the pain medication. Studies involving patients at least 18 years old with nonmalignant chronic pain were included. Studies of patients with acquired immune deficiency syndrome, cancer, and acute pain were excluded. Medline, CINAHL, PsychInfo, and Cochrane databases from 1985 to 2005 were searched. Reference lists were screened for relevant articles. Abstracts were screened for compliance with the study criteria, and the articles were obtained for those that met criteria. By using a systematic process, each article was subjected to repeated review and data abstracted to the collection sheets. Evidence tables were created to assist with data review. High levels of concern positively correlate with nonadherence, preconceived ideas about when the drug should start working can cause the patient to discontinue it before it begins to work, and patients may perceive that if medication is taken on a regular basis to control pain it may not be effective in the future if the pain increases. Research also showed that if patients perceived the benefits of taking the pain medication to be high, they were willing to risk the side effects.