Barriers and facilitators encountered by family physicians prescribing opioids for chronic non-cancer pain: a qualitative study

Goodwin, Joshua; Kirkland, Susan

doi:10.24095/hpcdp.41.6.03

Cited by 8 publications

(37 citation statements)

References 21 publications

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“… 44 GPs reported reasons for not referring to specialised pain centres or private specialists included long waitlists, lack of affordability and likelihood that these referrals would end in opioid prescription anyhow as. 42 44 GPs interviewed by Desveaux et al 38 wanted a more interdisciplinary approach for chronic pain management. GPs reported that an impaired kidney function and contraindications made other pharmacological options limited.…”

Section: Resultsmentioning

confidence: 99%

“…34–47 The sample size ranged from 5 to 27 GPs. Five studies included solely GPs,37 38 41 42 44 and remaining studies also interviewed other primary care providers (PCP). In the USA, the term PCP is used for physicians providing primary care and consists of family doctors, internists, paediatrics, geriatrics, gynaecologists and nurse practitioners and physician assistants 48.…”

Section: Resultsmentioning

confidence: 99%

“…As healers, GPs desire to relieve patient’s pain 37 38 42. The subjective nature of pain complicates this mandate 37 39.…”

Section: Resultsmentioning

confidence: 99%

“…The subjective nature of pain complicates this mandate 37 39. GPs interviewed by Desveaux et al 37 38 and Goodwin and Kirkland42 stated that before the opioid crisis, it was believed that chronic pain was often undertreated. Some GPs found that analgesics other than opioids were seldom sufficient for chronic pain 37 39.…”

Section: Resultsmentioning

confidence: 99%

“…GPs from Desveaux et al 37 reported that patients expect chronic pain to reach to zero. A range of emotional and psychosocial components contribute in maintaining chronic pain, making these expectations unrealistic 38 42. These GPs pleaded for more public awareness and education among patients regarding their pain 37…”

Section: Resultsmentioning

confidence: 99%

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General practitioners’ attitudes towards opioids for non-cancer pain: a qualitative systematic review

et al. 2022

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ObjectivesWorldwide the use of opioids, both doctor-prescribed and illicit, has increased. In most countries, opioids are first prescribed by general practitioners (GPs). Identifying factors that influence GPs’ opioid prescription decision-making may help reduce opioid misuse and overuse. We performed a systematic review to gain insight into GP attitudes towards opioid prescription and to identify possible solutions to promote changes in the field of primary care.Design and settingSystematic review of qualitative studies reporting GPs’ attitudes towards opioid use in non-cancer pain management.MethodsWe searched Embase, Medline, Web of Science Core Collection, Cochrane, PsychInfo, Cumulative Index to Nursing & Allied Health Literature (CINAHL) and Google Scholar. Two independent reviewers selected studies based on prespecified eligibility criteria. Study quality was evaluated with the Critical Appraisal Skills Programme checklist, and their results were analysed using thematic analysis. Quality of evidence was rated using the Grading of Recommendations Assessment, Development, and Evaluation—Confidence in the Evidence from Reviews of Qualitative research approach.ResultsWe included 14 studies. Four themes were established using thematic analyses: (1) GPs caught in the middle of ‘the opioid crisis’; (2) Are opioids always bad? (3) GPs’ weighing scale, taking patient-related and therapeutic relationship-related factors into account; and (4) GPs’ sense of powerlessness—lack of alternatives, support by specialists and lack of time in justifying non-prescriptions.ConclusionGP attitudes towards opioid prescribing for non-cancer pain are subject to several GP-related, patient-related and therapeutic relationship-related factors. Raising GP and patient awareness on the inefficacy of opioids in chronic non-cancer pain management and providing non-opioid alternatives to treat chronic pain might help to promote opioid reduction in primary care. More research is needed to develop practical guidelines on appropriate opioid prescribing, tapering off opioid use and adopting effective communication strategies.PROSPERO registration numberCRD42020194561.Cite Now

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

“…As healers, GPs desire to relieve patient’s pain 37 38 42. The subjective nature of pain complicates this mandate 37 39.…”

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

See 3 more Smart Citations

General practitioners’ attitudes towards opioids for non-cancer pain: a qualitative systematic review

et al. 2022

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Home care for patients with opioid use disorders: A qualitative study of registered nurses' experiences of pain management

Jakobsen,

Tørmoen,

Klarare

et al. 2024

Nursing Open

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AimTo explore registered nurses' experiences with pain management in patients with opioid use disorder (OUD) in home care.DesignQualitative explorative‐descriptive design.MethodsData were collected via nine individual semi‐structured interviews with registered nurses working in home care meeting patients with OUD. Data were analysed using systematic text condensation.ResultsThree categories were identified: Reciprocity in relationships and a professional approach enhance pain management; Discrepancies between guidelines, patient‐reported pain and RNs' observations challenge pain management; and Interprofessional collaboration makes or breaks pain management.

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A Scoping Review of Gaps Identified by Primary Care Providers in Caring for Patients with Chronic Noncancer Pain

McEwen

Esterlis

Lorello

et al. 2023

Canadian Journal of Pain

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Introduction/Aim Primary care providers (PCPs), who provide the bulk of care for patients with chronic noncancer pain (CNCP), often report knowledge gaps, limited resources, and difficult patient encounters while managing chronic pain. This scoping review seeks to evaluate gaps identified by PCPs in providing care to patients with chronic pain. Methods The Arksey and O’Malley framework was used for this scoping review. A broad literature search was conducted for relevant articles on gaps in knowledge and skills of PCPs and in their health care environment for managing chronic pain, with multiple search term derivatives for concepts of interest. Articles from the initial search were screened for relevance, yielding 31 studies. Inductive and deductive thematic analysis was adopted. Results The studies included in this review reflected a variety of study designs, settings, and methods. However, consistent themes emerged with respect to gaps in knowledge and skills for assessment, diagnosis, treatment, and interprofessional roles in chronic pain, as well as broader systemic issues including attitudes toward CNCP. A general lack of confidence in tapering high dose or ineffective opioid regimes, professional isolation, challenges in managing patients with CNCP with complex needs, and limited access to pain specialists were reported by PCPs. Discussion/Conclusions This scoping review revealed common elements across the selected studies that will be useful in guiding creation of targeted supports for PCPs to manage CNCP. This review also yielded insights for pain clinicians at tertiary centers for supporting their PCP colleagues as well as systemic reforms required to support patients with CNCP.

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Barriers and facilitators encountered by family physicians prescribing opioids for chronic non-cancer pain: a qualitative study

Cited by 8 publications

References 21 publications

General practitioners’ attitudes towards opioids for non-cancer pain: a qualitative systematic review

General practitioners’ attitudes towards opioids for non-cancer pain: a qualitative systematic review

Home care for patients with opioid use disorders: A qualitative study of registered nurses' experiences of pain management

A Scoping Review of Gaps Identified by Primary Care Providers in Caring for Patients with Chronic Noncancer Pain

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