Healthcare provider knowledge, beliefs, and attitudes regarding opioids for chronic non-cancer pain in North America prior to the emergence of COVID-19: A systematic review of qualitative research

Abstract

Background Balance between benefits and harms of using opioids for the management of chronic noncancer pain (CNCP) must be carefully considered on a case-by-case basis. There is no one-size-fits-all approach that can be executed by prescribers and clinicians when considering this therapy. Aim The aim of this study was to identify barriers and facilitators for prescribing opioids for CNCP through a systematic review of qualitative literature. Methods Six databases were searched from inception to June 2019 for qualitative studies reporting on provider knowledge, attitudes, beliefs, or practices pertaining to prescribing opioids for CNCP in North America. Data were extracted, risk of bias was rated, and confidence in evidence was graded. Results Twenty-seven studies reporting data from 599 health care providers were included. Ten themes emerged that influenced clinical decision making when prescribing opioids. Providers were more comfortable to prescribe opioids when (1) patients were actively engaged in pain self-management, (2) clear institutional prescribing policies were present and prescription drug monitoring programs were used, (3) long-standing relationships and strong therapeutic alliance were present, and (4) interprofessional supports were available. Factors that reduced likelihood of prescribing opioids included (1) uncertainty toward subjectivity of pain and efficacy of opioids, (2) concern for the patient (e.g., adverse effects) and community (i.e., diversion), (3) previous negative experiences (e.g., receiving threats), (4) difficulty enacting guidelines, and (5) organizational barriers (e.g., insufficient appointment duration and lengthy documentation). Conclusions Understanding barriers and facilitators that influence opioid-prescribing practices offers insight into modifiable targets for interventions that can support providers in delivering care consistent with practice guidelines.

Unraveling the Tapestry of Pain: A Comprehensive Review of Ethnic Variations, Cultural Influences, and Physiological Mechanisms in Pain Management and Perception

“…Neuropathic pain arises from damage or dysfunction of the nervous system [14]. It can be caused by conditions such as advanced diabetes, uncontrolled autoimmune diseases, various vasculitides, postherpetic neuralgia, and mechanical compression [6,12,15]. Neuropathic pain is characterized by unusual sensations like shooting or burning pain, tingling, numbness, or heightened sensitivity [16].…”

“…Furthermore, the impact of race on people's health and lived experiences has been scientifically proven, necessitating efforts to address disparities and advocate for equality [ 1 , 2 ]. Understanding the intricate nature of race is crucial for fostering inclusivity and working towards a society that values diversity while upholding principles of fairness and justice [ 6 ].…”

Physician perspectives on chronic pain management: barriers and the use of eHealth in the COVID-19 era

“…The present study was designed to achieve two main aims: (1) to gain physician's first-hand accounts of their current needs and barriers in providing chronic pain care to patients in British Columbia (BC), Canada, and (2) to assess their current use, interest, and perceived barriers to employing eHealth technology. Recent investigations into healthcare provider perspectives on chronic pain management and eHealth use in Canada have tended to focus on a specific pain condition (e.g., cancer [59], fibromyalgia [60], knee osteoarthritis [61]), domain of pain care (e.g., training [62], therapeutic cannabis [63], opioid prescribing [32,64,65], tele-mentoring [66]), or health profession (e.g., rheumatologists [67], pharmacists [68], and physician assistants [55]), with data collection occurring prior to the COVID-19 pandemic.…”

“…In addition, these patients tend to see their family physician twice as often as other patients and typically require longer appointments [14,[25][26][27]. This has placed a heavy demand on family physicians, who often report inadequate pain education and low confidence in their ability to manage chronic pain effectively [28][29][30][31][32]. Perhaps unsurprisingly, recent studies suggest that many physicians perceive the treatment of chronic pain as uniquely challenging, conveying feelings of exhaustion, frustration, and reduced job satisfaction [33,34].…”