Abstract
BACKGROUND: Chronic pain is a common patient complaint in primary care, yet providers and patients are often dissatisfied with treatment processes and outcomes.
OBJECTIVE: To assess provider satisfaction with their training for and current management of chronic pain in community clinic settings. To identify perceived problems with delivering chronic pain treatment and issues with opioid prescribing for chronic pain.
DESIGN: Mailed survey to primary care providers (PCPs) at 8 community clinics.
RESULTS: Respondents (N=111) included attendings, residents, and nurse practioners (NPs)/physician assistants (PAs). They reported 37.5% of adult appointments in a typical week involved patients with chronic pain complaints. They attributed problems with pain care and opioid prescribing more often to patient-related factors such as lack of self-management, and potential for abuse of medication than to provider or practice system factors. Nevertheless, respondents reported inadequate training for, and low satisfaction with, delivering chronic pain treatment.
CONCLUSIONS: A substantial proportion of adult primary care appointments involve patients with chronic pain complains. Dissatisfaction with training and substantial concerns about patient self-management and about opioid prescribing suggest areas for improving medical education and postgraduate training. Emphasis on patient-centered approaches to chronic pain management, including skills for assessing risk of opioid abuse and addiction, is required.
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References
Green CR, Wheeler JRC, Marchant B, LaPorte F, Guerrero E. Analysis of the physician variable in pain management. Pain Med. 2001;2:317–27.
Librach SL. Managing chronic pain in family practice. Can Fam Physician. 1993;39:539–44.
Potter M, Schafer S, Gonzalez-Mendez E, Gjeltema K, Lopez A, Croughan-Minihane M. Opioids for chronic nonmalignant pain: attitudes and practices of primary care physicians in the UCSG/Stanford Collaborative Research Network. J Fam Pract. 2001;50:145–51.
Ponte CD, Johnson-Tribino J. Attitudes and knowledge about pain: an assessment of West Virginia family physicians. Fam Med. 2005;37:477–80.
Bendsen P, Hensing G, Ebeling C, Schedin A. What are the qualities of dilemmas experienced when prescribing opioids in general practice? Pain. 1999;82:89–96.
Moulin ED, Clark AJ, Speechley M, Morley-Forster PK. Chronic pain in Canada—prevalence, treatment, impact and the role of opioid analgesia. Pain Res Manag. 2002;7:170–73.
Olsen Y, Daumit GL. Opioid prescribing for chronic nonmalignant pain in primary care: challenges and solutions. Adv Psychosom Med. 2004;25:138–50.
Clark JD. Chronic pain prevalence and analgesic prescribing in a general medical population. J Pain Symptom Manage. 2002;23:131–7.
Green CR, Anderson KO, Baker TA, et al. The unequal burden of pain: confronting racial and ethnic disparities in pain. Pain Med. 2003;4:277–294.
Ng B, Dimsdale JE, Rollnik JD, Shapiro H. The effect of ethnicity on prescriptions for patient-controlled analgesia for post-operative pain. Pain. 1996;66:9–12.
Edwards CL, Fillingim RB, Keefe F. Race, ethnicity and pain. Pain. 2001;94:133–7.
Edwards RR, Doleys DM, Fillingim RB, Lowery D. Ethnic differences in pain tolerance: clinical implications in a chronic pain population. Psychosom Med. 2001;63:316–23.
Won A, Lapan K, Gambassi G, Bernabei R, Mor V, Lipsitz LA. Correlates and management of nonmalignant pain in the nursing home. J Am Gerontol Soc. 1999;47:936–42.
Dominick KL, Dudley TK, Grambow SC, et al. Racial differences in health care utilization among patients with osteoarthritis. J Rheumatol. 2003;30:2201–6.
Tamayo-Sarver JH, Dawson NV, Hinze SW, et al. The effect of race/ethnicity and desirable social characteristics on physician’s decisions to prescribe opioid analgesics. Acad Emerg Med. 2003;10:1239–48.
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The authors have no conflicts of interest to declare.
Presentations: Preliminary findings from this study were reported at the following: Society of Teachers of Family Medicine, September 2003, Atlanta GA; American Public Health Association, November 2003, San Francisco, CA; American Public Health Association, November 2004, Washington, DC.
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Upshur, C.C., Luckmann, R.S. & Savageau, J.A. Primary care provider concerns about management of chronic pain in community clinic populations. J Gen Intern Med 21, 652–655 (2006). https://doi.org/10.1111/j.1525-1497.2006.00412.x
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DOI: https://doi.org/10.1111/j.1525-1497.2006.00412.x