Risk assessment and counseling behaviors of healthcare professionals managing patients with chronic pain: A national multifaceted assessment of physicians, pharmacists, and their patients


  • Gregory D. Salinas, PhD
  • Debi Susalka
  • B. Stephen Burton, MS
  • Nancy Roepke, MBA
  • Kimberly Evanyo
  • David Biondi, DO
  • Susan Nicholson, MD




opioids, risk assessment, counseling, practice patterns, chronic pain


Introduction: Due to the significant and increasing problem of chronic pain in the United States, pain management is a frequent need in many healthcare settings. At the same time, there has been rising concern with the abuse/misuse and potential for addiction to opioid therapies. This study was conducted to better understand healthcare professionals’ current knowledge, perceptions, and clinical practice patterns regarding prescribing of extended-release or long-acting opioid therapy to patients with chronic pain.

Methods: This study was conducted from March 2011 to May 2011; it utilized a nationally distributed case vignette survey of primary care physicians (PCPs), pain specialists, and pharmacists, along with nested chart reviews and surveys of patients with chronic pain.

Results: Many PCPs are inadequately performing opioid risk assessments and there is variability in interpreting a patient’s opioid risk, resulting in misestimated risk. Physicians underutilize urine drug screens and written opioid use agreements when initiating opioid therapy in patients. Physicians and pharmacists often omit key messages during patient counseling about safe use of opioids and safe medication storage. Among pharmacists, safety counseling is generally limited to alerting patients to potential side effects. For most PCPs, difficulty managing patients with risk factors for opioid use and uncertainty about managing first line opioid efficacy failure are significant barriers to effective management of chronic pain.

Conclusions: Patients having chronic pain and concomitant risk factors for opioid abuse, misuse, and diversion are prevalent, yet many physicians, especially PCPs, are uncomfortable managing opioid therapy in such patients. Education on best practices for risk assessment, patient monitoring during treatment, strategies for more effective counseling, patient chart documentation, and management strategies to enhance effective treatment of chronic pain are essential to ensure that PCPs and specialists maximize effective and safe use of opioid medications. Pharmacists could be a valuable member of this interdisciplinary team and should be involved in patient counseling and monitoring for aberrant behavior.

Author Biographies

Gregory D. Salinas, PhD

CEOutcomes, LLC, Birmingham, Alabama

Debi Susalka

CEOutcomes, LLC, Birmingham, Alabama

B. Stephen Burton, MS

CEOutcomes, LLC, Birmingham, Alabama

Nancy Roepke, MBA

CEOutcomes, LLC, Birmingham, Alabama

Kimberly Evanyo

Janssen Scientific Affairs, LLC, Raritan, New Jersey

David Biondi, DO

Janssen Scientific Affairs, LLC, Raritan, New Jersey

Susan Nicholson, MD

Janssen Scientific Affairs, LLC, Raritan, New Jersey


Smith BH, Elliott AM, Chambers WA, et al.: The impact of chronic pain in the community. Fam Pract. 2001; 18: 292-299.

The Mayday Fund: A call to revolutionize chronic pain care in America: An opportunity in health care reform chronic pain in 2010. Available at http://www.maydaypainreport.org/report.php. Accessed June 14, 2012.

Alliance of State Pain Initiatives (ASIP): Professional pain education. Available at http://aspi.wisc.edu/. Accessed June 14, 2012.

Chou R, Fanciullo GJ, Fine PG, et al.: Clinical guidelines for the use of chronic opioid therapy in chronic noncancer pain. J Pain. 2009; 10(2): 113-130.

Passik SD, Kirsh KL: The need to identify predictors of aberrant drug-related behavior and addiction in patients being treated with opioids for pain. Pain Med. 2003; 4(2): 186-189.

Peabody JW, Luck J, Glassman P, et al.: Comparison of vignettes, standardized patients, and chart abstraction: A prospective validation study of 3 methods for measuring quality. JAMA. 2000; 283: 1715-1722.

Peabody JW, Luck J, Glassman P, et al.: Measuring the quality of physician practice by using clinical vignettes: A prospective validation study. Ann Intern Med. 2004; 141: 771-780.

US Department of Health and Human Services, Food and Drug Administration: Draft blueprint for prescriber education for long-acting/extended-release opioid class-wide risk evaluation and mitigation strategy; availability; request for comments. Available at http://www.gpo.gov/fdsys/pkg/FR-2011-11-07/pdf/2011-28669.pdf. Accessed June 14, 2012.

Nafziger AN, Bertino JS: Utility and application of urine drug testing in chronic pain management with opioids. Clin J Pain. 2009; 25(1): 73-79.

Christo PJ, Manchikanti L, Ruan X, et al.: Urine drug testing in chronic pain. Pain Physician. 2011; 14(2): 123-143.

Reisfield GM, Salazar E, Bertholf RL: Rational use and interpretation of urine drug testing in chronic opioid therapy. Ann Clin Lab Sci. 2007; 37(4): 301-314.

Laffer Associates and Millennium Research Institute: An economic analysis of the costs and benefits associated with regular urine drug testing for chronic pain patients in the United States. Available at http://www.millenniumresearchinstitute.org/wpcontent/uploads/2011/10/Full-Study-Laffer-MRI-Economic-Analysis-of-UDT-Released_2011-10-03.pdf. Accessed October 27, 2011.

Substance Abuse and Mental Health Services Administration: Results from the 2010 National Survey on Drug Use and Health: Summary of National Findings, NSDUH Series H-41, HHS Publication No. (SMA) 11-4658. Rockville, MD: Substance Abuse and Mental Health Services Administration, 2011.

Chen L, Houghton M, Seefeld L, et al.: Opioid therapy for chronic pain: Physicians’ attitude and current practice patterns. J Opioid Manage. 2011; 7: 267-276.



How to Cite

Salinas, PhD, G. D., D. Susalka, B. S. Burton, MS, N. Roepke, MBA, K. Evanyo, D. Biondi, DO, and S. Nicholson, MD. “Risk Assessment and Counseling Behaviors of Healthcare Professionals Managing Patients With Chronic Pain: A National Multifaceted Assessment of Physicians, Pharmacists, and Their Patients”. Journal of Opioid Management, vol. 8, no. 5, Sept. 2012, pp. 273-84, doi:10.5055/jom.2012.0127.