Pain Management by Primary Care Physicians, Pain Physicians, Chiropractors, and Acupuncturists: A National Survey

Breuer, Brenda; Cruciani, Ricardo A.; Portenoy, Russell K.

doi:10.1097/smj.0b013e3181e74ede

Cited by 128 publications

(109 citation statements)

References 14 publications

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“…Chronic pain, Self management, Doctor-patient communication, Patient-centered care, Adherence Pain is one of the most common presenting problems in medical settings [1], and the majority of pain treatment tends to be carried out in the primary care context [2]. Pain that persists beyond 3 months and that does not remit with typical treatments for acute pain, such as rest, non-steroidal anti-inflammatory drugs, and heat or ice, is considered chronic pain.…”

Section: Introductionmentioning

confidence: 99%

Providers' roles in enhancing patients' adherence to pain self management

Dorflinger

Kerns

Auerbach

2012

Behav. Med. Pract. Policy Res.

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Practice guidelines and empirical research related to pain management encourage clinicians to take active roles in providing education about self management and promoting adoption of a self-management approach. The purpose of the study was to review the relevant literature, summarize aspects of the patientprovider interaction that influence patient engagement in self management for chronic pain, and outline practice recommendations in this area. Review of the literature on aspects of the patient-provider interaction that promote engagement in pain self-management was used. Findings are synthesized into recommendations for providers. Patients benefit from a biopsychosocial and patient-centered approach. Patients are more likely to fully disclose when providers respond empathically, which can improve conceptualization and treatment. Patient education and motivation play important roles in engaging patients in self management. Self management is influenced in part by the patient-provider communication process. Suggestions for communication strategies to facilitate patient engagement in self-management techniques, including empathic discussion of barriers and motivation enhancement, are provided. KEYWORDSChronic pain, Self management, Doctor-patient communication, Patient-centered care, Adherence Pain is one of the most common presenting problems in medical settings [1], and the majority of pain treatment tends to be carried out in the primary care context [2]. Pain that persists beyond 3 months and that does not remit with typical treatments for acute pain, such as rest, non-steroidal anti-inflammatory drugs, and heat or ice, is considered chronic pain. It is estimated that more than 100 million Americans have chronic pain [3], and prevalence in other countries varies from about 10-50 % of the general population [4]. Not only is chronic pain a prevalent health issue but it also significantly impacts quality of life [5][6][7][8] and the costs of care, and lost productivity are estimated to total almost $635 billion each year [3].Pain guidelines have recommended selfmanagement strategies in the treatment of chronic pain [9,10]. Self management differs from other treatments such as surgery and medication in that it emphasizes the patient's own control over his/her pain experience rather than relying on external factors to treat pain symptoms. At its most rudimentary level, self management consists of basic methods such as distraction, physical activity, and ice or heat to manage pain. Many patients use these practices on their own or are able to easily implement them after receiving reassurance and encouragement from their providers. Other patients may benefit from additional self-management techniques, such as those emphasized in cognitivebehavioral treatment for chronic pain, that aim to modify the thoughts and behaviors that contribute to the maintenance and exacerbation of pain. Such self-management skills include time-based pacing, relaxation, stress management, and identifying and modifying catastrophic ...

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Section: Introductionmentioning

confidence: 99%

Providers' roles in enhancing patients' adherence to pain self management

Dorflinger

Kerns

Auerbach

2012

Behav. Med. Pract. Policy Res.

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“…Les médecins de première ligne prennent soin de 52 % des patients atteints de douleur chronique aux É tats-Unis, et de 70 % en Europe. 10,11 Bien que bon nombre de ces médecins sachent comment procurer des soins de la douleur exemplaires, leur expérience n'est pas uniforme. Plusieurs obstacles entravent la fourniture de soins de douleur optimaux dans le système de soins de première ligne, notamment l'attitude des fournisseurs, le manque de formation des médecins (moins de quatre heures de formation en douleur chronique au cours de leur résidence de deux ans au Canada), les attitudes culturelles des patients, l'accès aux traitements (médicaments, physiothérapie, consultations psychologiques), des obstacles géographiques, les limites réglementaires (absence d'une mise en réseau nationale ou régionale des dossiers médicaux ou des prescriptions), etc.…”

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“…Primary care physicians are responsible for the care of 52% of chronic pain patients in the United States and 70% in Europe. 10,11 Although many primary care practitioners are proficient in providing exemplary pain care, this is not a uniform experience. A number of barriers impede optimal pain care within the primary care system, including provider attitudes, lack of physician training (less than four hours of chronic pain training in their two-year residencies in Canada), patient cultural attitudes, access to treatment (drugs, physiotherapy, psychologist), geographical barriers, regulatory limitation (lack of national or regional networking of medical records or prescriptions), and so on.…”

mentioning

confidence: 99%

The known knowns and known unknowns of chronic pain

Peng

2016

Can J Anesth/J Can Anesth

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“…1 This is particularly onerous for primary care physicians (PCPs), who are responsible for providing pain care to more than half of all chronic pain patients. 3 The majority of these PCPs do not have the time or training in pain medicine or addiction to effectively assess and manage these complex patients. 4 Further complicating the addicted patient receiving care are certain barriers, such as the stigma of being labeled as drug seeking or an addict, which encourage an afflicted patient to hide his or her addiction.…”

Section: Introductionmentioning

confidence: 99%

Treating Pain in Addicted Patients: Recommendations from an Expert Panel

Cheatle

Comer

Wunsch³

et al. 2014

Population Health Management

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Clinicians may face pragmatic, ethical, and legal issues when treating addicted patients. Equal pressures exist for clinicians to always address the health care needs of these patients in addition to their addiction. Although controversial, mainly because of the lack of evidence regarding their long-term efficacy, the use of opioids for the treatment of chronic pain management is widespread. Their use for pain management in the addicted population can present even more challenges, especially when evaluating the likelihood of drug-seeking behavior. As the misuse and abuse of opioids continues to burgeon, clinicians must be particularly vigilant when prescribing chronic opioid therapy. The purpose of this article is to summarize recommendations from a recent meeting of experts convened to recommend how primary care physicians should approach treatment of chronic pain for addicted patients when an addiction specialist is not available for a referral. As there is a significant gap in guidelines and recommendations in this specific area of care, this article serves to create a foundation for expanding chronic pain guidelines in the area of treating the addicted population. This summary is designed to be a practical how-to guide for primary care physicians, discussing risk assessment, patient stratification, and recommended therapeutic approaches. (Population Health Management 2014;17:79-89)

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Pain Management by Primary Care Physicians, Pain Physicians, Chiropractors, and Acupuncturists: A National Survey

Cited by 128 publications

References 14 publications

Providers' roles in enhancing patients' adherence to pain self management

Providers' roles in enhancing patients' adherence to pain self management

The known knowns and known unknowns of chronic pain

Treating Pain in Addicted Patients: Recommendations from an Expert Panel

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