Chronic noncancer pain management in primary care: family medicine physicians’ risk assessment of opioid misuse

Kavukçu, Ethem; Akdeniz, Melahat; Avcı, Hasan Hüseyin; Altuğ, Mehmet; Öner, Mehmet

doi:10.1080/00325481.2015.993572

Cited by 16 publications

(12 citation statements)

References 30 publications

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“…But, this may reflect a basic lack of understanding that many pain conditions, such as centralized pain, cannot be assessed with routine physical exam or standard X-Ray, MRI, or CT imaging techniques [ 36 ]. Consistent with the literature ([ 37 , 38 ], we also found that physicians often rely on tacit assessments of patients’ risk of aberrant drug-related behaviors, such as opioid abuse, despite recognizing they may make inaccurate assessments. Therefore, clinical leaders, educators and policymakers must continue to create and disseminate usable, evidence-based education on chronic pain and opioid risk assessment.…”

Section: Discussionsupporting

confidence: 87%

Decision support for chronic pain care: how do primary care physicians decide when to prescribe opioids? a qualitative study

et al. 2015

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BackgroundPrimary care physicians struggle to treat chronic noncancer pain while limiting opioid misuse, abuse, and diversion. The objective of this study was to understand how primary care physicians perceive their decisions to prescribe opioids in the context of chronic noncancer pain management. This question is important because interventions, such as decision support tools, must be designed based on a detailed understanding of how clinicians use information to make care decisions.MethodsWe conducted in-depth qualitative interviews with family medicine and general internal medicine physicians until reaching saturation in emergent themes. We used a funneling approach to ask a series of questions about physicians’ general decision making challenges and use of information when considering chronic opioids. We then used an iterative, open-coding approach to identify and characterize themes in the data.ResultsWe interviewed fifteen physicians with diverse clinical experiences, demographics, and practice affiliations. Physicians said that general decision making challenges in providing pain management included weighing risks and benefits of opioid therapies and time and resource constraints. Also, some physicians described their active avoidance of chronic pain treatment due to concerns about opioid risks. In their decision making, physicians described the importance of objective and consistent information, the importance of identifying “red flags” related to risks of opioids, the importance of information about physical function as an outcome, and the importance of information that engenders trust in patients.ConclusionsThis study identified and described primary care physicians’ struggles to deliver high quality care as they seek and make decisions based on an array of incomplete, conflicting, and often untrusted patient information. Decision support systems, education, and other interventions that address these challenges may alleviate primary care physicians’ struggles and improve outcomes for patients with chronic pain and other challenging conditions.

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Section: Discussionsupporting

confidence: 87%

Decision support for chronic pain care: how do primary care physicians decide when to prescribe opioids? a qualitative study

et al. 2015

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“…As such, a lot of surveys including various specialties like family physicians, surgical interns, obstetrician-gynecologists call for better opioid prescribing training and education [19-21]. In another study where the intervention group received education on the assessment of the risk of opioid misuse, the rate of eagerness to apply risk assessment increased markedly [22]. By adapting curricula to address the rising opioid epidemic, medical schools have the potential to ensure that future physicians can effectively recognize the signs, symptoms, and risks of opioid abuse and improve patient outcomes [23].…”

Section: Discussionmentioning

confidence: 99%

Opioids Use and Abuse: Prescription Practice, Attitude, and Beliefs among Doctors of Karachi

Majid

Tanveer

Asghar

et al. 2019

Cureus

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BackgroundOpioid analgesics, also known as narcotics, are medicinal drugs used primarily for the management of pain secondary to any type of cancer, severe injury or surgery. Due to the ease of availability, opioids are commonly abused. In 2015, reported deaths exceeded 33,000 Americans from opioid overdose. A survey in 2013 revealed nearly 1.6 million Pakistanis abusing prescription opioids for non-medical needs. Although commonly prescribed by primary care physicians, most of them are diffident to stand by all the recommended strategies to reduce the incidence of opioid abuse.MethodsA cross-sectional study was conducted during the period of August through October 2018. A sample size of 365 was determined using a 95% confidence interval at a degree of precision of 5%. A 22-item questionnaire was given to doctors with at least two years practicing experience either from a private or a public healthcare setup. Doctors who had never prescribed opioids were excluded from the study. Out of the eligible participants, 15 refused to take part in the survey, and the co-operation rate was recorded as 95.8%. Collected data were analyzed using statistical package for social science (SPSS) version 22 for Windows. Frequencies, percentages, mean, standard deviation, and chi-square were used to explore the variables. The statistical significance level was considered at p < 0.5.ResultsOpioids were reported to be used mainly for treating acute pain (40.5%), chronic pain (24.7%) and both acute and chronic (34.8%). A minority of doctors (29%) screened their patients for opioid addiction. A significant association (p = 0.000) between the frequency of opioid prescription and prior screening for depression was determined. Surprisingly, only 23.2% clinicians frequently screened their patients for depression before prescribing opioids. The rate of counselling regarding drug tapering was found to be 71.6%. A majority, i.e., 88%, of the respondents anticipated the misuse of opioids they prescribe whereas 74% also held a belief that patients self-medicate their untreated pain. Participants reported addiction (54%) as the most common reason for abuse followed by the role of pharmaceutical companies (43%) and pharmacies (41%). About 80.2% clinicians believed that patients addicted to opioids could get well and return to their daily routine.ConclusionThe rising opioid epidemic is a major concern for doctors prescribing opioids. Adaptation of medical school curricula and appropriate training can equip doctors for better management of patients requiring opioids. This includes the screening of patients using standard risk assessment tools for opioid abuse leading to a more controlled opioid prescription practice. Dissemination of these tools will boost doctors' confidence and may help in reducing morbidity and mortality from opioid abuse.

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“…Previous provider surveys 6,[19][20][21] have identified CME as a viable means to increase provider knowledge and competency in managing CNCP. A pre-post survey of 45 resident physicians who underwent a focused educational training module on opioid prescribing for CNCP demonstrated increased knowledge and confidence in opioid prescribing.…”

Section: Discussionmentioning

confidence: 99%

Does familiarity with CDC guidelines, continuing education, and provider characteristics influence adherence to chronic pain management practices and opioid prescribing?

McCalmont¹,

Jones²,

Bennett³

et al. 2018

J of Opioid Management

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Chronic noncancer pain management in primary care: family medicine physicians’ risk assessment of opioid misuse

Cited by 16 publications

References 30 publications

Decision support for chronic pain care: how do primary care physicians decide when to prescribe opioids? a qualitative study

Decision support for chronic pain care: how do primary care physicians decide when to prescribe opioids? a qualitative study

Opioids Use and Abuse: Prescription Practice, Attitude, and Beliefs among Doctors of Karachi

Does familiarity with CDC guidelines, continuing education, and provider characteristics influence adherence to chronic pain management practices and opioid prescribing?

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