Attitudes of Primary Care Practitioners in Managing Chronic Pain Patients Prescribed Opioids for Pain: A Prospective Longitudinal Controlled Trial

• Published in: Pain medicine (Malden, Mass.) Mass.), 2016-01, Vol.17 (1), p.99-113
• Main Authors: Jamison, Robert N., Scanlan, Elizabeth, Matthews, Michele L., Jurcik, Dylan C., Ross, Edgar L.
• Format: Article
• Language: English
• Subjects: Adult; Aged; Analgesics; Analgesics, Opioid - therapeutic use; Attitude of Health Personnel; Chronic pain; Chronic Pain - drug therapy; Female; Humans; Longitudinal Studies; Male; Middle Aged; Mood; Narcotics; Opioid-Related Disorders - drug therapy; Opioids; Pain; Pain Management; Patient Compliance - psychology; Physicians, Primary Care; Prescriptions; Primary care; Prospective Studies; Risk Assessment; Surveys and Questionnaires
• ISSN: 1526-2375; 1526-4637
• DOI: 10.1111/pme.12871

Abstract Objective. There is increasing concern among primary care practitioners (PCPs) regarding medication misuse and noncompliance among chronic pain patients prescribed opioids for pain. This study investigated the benefits of interventions designed to track potential opioid misuse and to improve practitioner confidence in managing patients with chronic pain through the use of risk assessment, monthly monitoring of compliance, and specialty support. Methods. Fifty-six PCPs and 253 chronic pain patients were recruited into the study. All patients were assessed for risk and called once a month for 6 months to monitor pain and opioid compliance. Practitioner knowledge about opioids, concerns about analgesic prescriptions, practice behavior, and attitudes of managing chronic pain patients were assessed and questionnaires were repeated after 1 year. Practitioners in the experimental group received monthly patient summary reports that consisted of pain, mood, activity levels, healthcare utilization, and results of the Opioid Compliance Checklist, while practitioners in the control group did not receive the monthly reports. Results. After 1 year all the PCPs reported improvement in identifying patients at risk for misuse (P < 0.05), perceived confidence in prescribing opioids for pain (P < 0.05) and increased satisfaction with communication with pain specialists (P < 0.05). The patients reported greater compliance with their opioid medication and felt that the monthly monitoring was beneficial. Despite modest improvements, many PCPs still lacked confidence in managing pain patients and reported reluctance to prescribe opioids for chronic noncancer pain, especially among younger practitioners. This study demonstrates the benefits of careful monitoring of chronic pain patients and need for pain management support within primary care.