Primary care provider concerns about management of chronic pain in community clinic populations


BACKGROUND: Chronic pain is a common patient complaint in primary care, yet providers and patients are often dissatisfied with treatment processes and outcomes.

OBJECTIVE: To assess provider satisfaction with their training for and current management of chronic pain in community clinic settings. To identify perceived problems with delivering chronic pain treatment and issues with opioid prescribing for chronic pain.

DESIGN: Mailed survey to primary care providers (PCPs) at 8 community clinics.

RESULTS: Respondents (N=111) included attendings, residents, and nurse practioners (NPs)/physician assistants (PAs). They reported 37.5% of adult appointments in a typical week involved patients with chronic pain complaints. They attributed problems with pain care and opioid prescribing more often to patient-related factors such as lack of self-management, and potential for abuse of medication than to provider or practice system factors. Nevertheless, respondents reported inadequate training for, and low satisfaction with, delivering chronic pain treatment.

CONCLUSIONS: A substantial proportion of adult primary care appointments involve patients with chronic pain complains. Dissatisfaction with training and substantial concerns about patient self-management and about opioid prescribing suggest areas for improving medical education and postgraduate training. Emphasis on patient-centered approaches to chronic pain management, including skills for assessing risk of opioid abuse and addiction, is required.

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Corresponding author

Correspondence to Dr. Carole C. Upshur EdD.

Additional information

The authors have no conflicts of interest to declare.

Presentations: Preliminary findings from this study were reported at the following: Society of Teachers of Family Medicine, September 2003, Atlanta GA; American Public Health Association, November 2003, San Francisco, CA; American Public Health Association, November 2004, Washington, DC.

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Upshur, C.C., Luckmann, R.S. & Savageau, J.A. Primary care provider concerns about management of chronic pain in community clinic populations. J Gen Intern Med 21, 652 (2006).

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Key words

  • pain
  • primary care
  • vulnerable populations
  • physician satisfaction
  • medical education