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Seeking Rural Solutions for Chronic Pain
“It’s like running on a treadmill that never stops – no matter how hard I try, I never seem to get any closer to relief.”
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This persona reflects experiences shared by people living with chronic pain in rural and remote communities. It does not represent all perspectives. Instead, it highlights patterns and challenges from patient interviews, particularly related to communication in primary care
Chronic pain is complex and deeply personal. It may be constant or fluctuating, with known or uncertain causes. It can affect mobility, sleep, mental health, employment, relationships, and experiences in care. There is no single way to experience or manage pain.
These challenges are often compounded by structural barriers:
Jesse's experience supports reflection on:
This persona highlights several important tensions that shape patient experience:
Some of the patients interviewed that inform Jesse's experience shared how their pain management and care decisions were influenced by past substance use – which are complex dynamics to navigate for both patients and providers.
We've handled this topic carefully, recognizing that pain, substance use history, and living in a rural area are connected. It's important to approach experiences like these with good judgment, compassion, and an understanding of the bigger system affecting people's lives.
I've been with my doctor for about 13 years. He's kind and personable but not as proactive as I'd like.
I stay with him mostly because we've been together so long now, and finding a new doctor along with the specialists and healthcare services to manage chronic pain isn't easy – especially in rural Alberta.
I have recurring shoulder pain. I see my doctor for testing, prescription renewals, and pain management. Over the years, I've had other health issues that come on suddenly and usually don't last very long. These have been difficult to diagnose. Sometimes I end up in emergency.
I feel frustrated because medication is often the only solution offered, which concerns me due to my history with addiction. My concerns aren't taken seriously or explored. I rarely get asked questions. I don't feel like I have a real choice with my doctor, and I'm left wondering if I'll get referrals or care I need.
While my children's concerns seem to be addressed (thankfully), I often feel overlooked, unheard, and unsure if my doctor is understanding. Small-town challenges add to my frustrations, especially after my divorce when I felt I was treated differently and later discovered a breach of my healthcare privacy.
Listen to Jesse describe how they feel about their care.
I've learned how I present my concerns is crucial to advocating for my care. I research my health issues and carefully prepare questions to guide the conversation, so my concerns are heard, but this isn't always met with meaningful engagement or helpful solutions.
Listen to Jesse describe how they prepare for appointments.
Listen to Jesse describe what they need from their healthcare team.
These questions are intended to encourage individual reflection on Jesse’s experience and identify opportunities to improve the quality of care for people with similar experiences.
The quality dimensions provide a common language for understanding quality as it should be experienced by people.
The questions that follow invite you to consider Jesse’s story through the interconnected dimensions of People-centred, Accessible and timely, and Effective, while recognizing that other dimensions may also be relevant.
The wholistic preferences, needs, and strengths of people and communities matter.
Jesse is a single parent balancing work, raising two children, and living with chronic pain. They prepare carefully for appointments, consult trusted health information, and actively follow up on referrals and test results. Because of a history of substance use, Jesse hopes to explore effective alternatives to prescription medication where appropriate. While managing pain remains important, Jesse also wants to be heard, involved in decisions, and treated as an active partner in their care.
What aspects of Jesse’s responsibilities, priorities, and lived experience must be understood to support care that reflects what matters most to Jesse?
People can readily access services that meet their needs.
Living in a rural community shapes Jesse’s healthcare options. Limited access to providers and specialists means Jesse often takes responsibility for following up on referrals, test results, and appointments to keep their care moving forward. Over time, this creates the exhausting experience of “chasing care.”
How does Jesse’s experience of “chasing care” affect their ability to care for themselves, support their children, and manage their overall well-being?
Decisions are based on current evidence and lived experience.
Although Jesse consistently prepares for appointments and follows through on care team recommendations, they feel their care focuses primarily on symptom management rather than understanding the underlying causes of their pain. Jesse is looking for honest conversations, meaningful options, and a shared plan that brings together their lived experience with the healthcare team’s clinical expertise.
Based on Jesse’s experience, what might care look like if it is both clinically appropriate and meaningful in the context of Jesse’s life?
Are there other quality dimensions that are also relevant to Jesse’s experience
The Alberta Quality Dimensions for Health are one part of the Framework for an Integrated People-centred Health System. The Framework also includes enablers, which create the conditions that support quality care, and shared responsibilities, which describe how we show up with and for one another.
Explore the Framework to learn how the dimensions, enablers, and shared responsibilities work together to support an integrated people-centred health system.
These questions invite you to consider how the insights gained through reflection and exploration could inform improvements within your own practice, team, organization, community, or the broader health system.
These resources build on the reflections and insights gained through this persona and support team discussion, quality improvement, and a deeper understanding of this topic.
Facilitate team learning: Continue the conversation with your team using the Persona Facilitation Guide: Open the Jesse chapter (future link page/pdf), which includes facilitation tips, discussion activities, and planning tools.
Support improvement: Learn how you can support providers using the personas for quality improvement with the Physician Practice Improvement Program (PPIP) Fact Sheet: Personas (future link). Also, check out the following Health Quality Alberta resources:
Expand your knowledge: Explore additional clinical, community, and educational resources related to the topics explored through this persona.
These questions are intended to encourage reflection on Jesse’s experience and help make connections with your own experiences or those of someone you care about.
These resources build on the reflections and insights gained through this persona and provide additional information and resources related to this topic.
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