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

Abstract

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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References

  1. 1.

    Green CR, Wheeler JRC, Marchant B, LaPorte F, Guerrero E. Analysis of the physician variable in pain management. Pain Med. 2001;2:317–27.

    Article  CAS  PubMed  Google Scholar 

  2. 2.

    Librach SL. Managing chronic pain in family practice. Can Fam Physician. 1993;39:539–44.

    CAS  PubMed  Google Scholar 

  3. 3.

    Potter M, Schafer S, Gonzalez-Mendez E, Gjeltema K, Lopez A, Croughan-Minihane M. Opioids for chronic nonmalignant pain: attitudes and practices of primary care physicians in the UCSG/Stanford Collaborative Research Network. J Fam Pract. 2001;50:145–51.

    CAS  PubMed  Google Scholar 

  4. 4.

    Ponte CD, Johnson-Tribino J. Attitudes and knowledge about pain: an assessment of West Virginia family physicians. Fam Med. 2005;37:477–80.

    PubMed  Google Scholar 

  5. 5.

    Bendsen P, Hensing G, Ebeling C, Schedin A. What are the qualities of dilemmas experienced when prescribing opioids in general practice? Pain. 1999;82:89–96.

    Article  Google Scholar 

  6. 6.

    Moulin ED, Clark AJ, Speechley M, Morley-Forster PK. Chronic pain in Canada—prevalence, treatment, impact and the role of opioid analgesia. Pain Res Manag. 2002;7:170–73.

    Google Scholar 

  7. 7.

    Olsen Y, Daumit GL. Opioid prescribing for chronic nonmalignant pain in primary care: challenges and solutions. Adv Psychosom Med. 2004;25:138–50.

    Article  PubMed  Google Scholar 

  8. 8.

    Clark JD. Chronic pain prevalence and analgesic prescribing in a general medical population. J Pain Symptom Manage. 2002;23:131–7.

    Article  PubMed  Google Scholar 

  9. 9.

    Green CR, Anderson KO, Baker TA, et al. The unequal burden of pain: confronting racial and ethnic disparities in pain. Pain Med. 2003;4:277–294.

    Article  PubMed  Google Scholar 

  10. 10.

    Ng B, Dimsdale JE, Rollnik JD, Shapiro H. The effect of ethnicity on prescriptions for patient-controlled analgesia for post-operative pain. Pain. 1996;66:9–12.

    Article  CAS  PubMed  Google Scholar 

  11. 11.

    Edwards CL, Fillingim RB, Keefe F. Race, ethnicity and pain. Pain. 2001;94:133–7.

    Article  CAS  PubMed  Google Scholar 

  12. 12.

    Edwards RR, Doleys DM, Fillingim RB, Lowery D. Ethnic differences in pain tolerance: clinical implications in a chronic pain population. Psychosom Med. 2001;63:316–23.

    CAS  PubMed  Google Scholar 

  13. 13.

    Won A, Lapan K, Gambassi G, Bernabei R, Mor V, Lipsitz LA. Correlates and management of nonmalignant pain in the nursing home. J Am Gerontol Soc. 1999;47:936–42.

    CAS  Google Scholar 

  14. 14.

    Dominick KL, Dudley TK, Grambow SC, et al. Racial differences in health care utilization among patients with osteoarthritis. J Rheumatol. 2003;30:2201–6.

    PubMed  Google Scholar 

  15. 15.

    Tamayo-Sarver JH, Dawson NV, Hinze SW, et al. The effect of race/ethnicity and desirable social characteristics on physician’s decisions to prescribe opioid analgesics. Acad Emerg Med. 2003;10:1239–48.

    Article  PubMed  Google Scholar 

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Correspondence to Dr. Carole C. Upshur EdD.

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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). https://doi.org/10.1111/j.1525-1497.2006.00412.x

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Key words

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