Opioid therapy for chronic pain: Physicians’ attitude and current practice patterns

Authors

  • Lucy Chen, MD
  • Mary Houghton, BA
  • Lindsey Seefeld, BS
  • Charlene Malarick, BSN, RN
  • Jianren Mao, MD, PhD

DOI:

https://doi.org/10.5055/jom.2011.0068

Keywords:

opioid, survey, practice pattern, chronic pain

Abstract

Although opioid therapy is widely used for the treatment of chronic pain conditions, there is a lack of consensus on a number of practical issues related to the use of prescription opioids. The authors conducted a comprehensive practice-oriented survey to examine physicians’ attitudes, knowledge, experience, and practice patterns regarding opioid therapy for chronic pain management. The survey was conducted during 2007 and 2008 through nationwide direct mails and e-mails to physicians who are currently practicing in the United States. The survey contained 23 questions divided into six categories: (1) physicians’ overall view on opioid therapy for chronic pain management; (2) clinical indications for opioid therapy; (3) patient-related factors influencing the decision to begin opioid therapy; (4) effectiveness of opioid therapy; (5) choice of opioid regimen; and (6) opioid agreement and opioid abuse behavior. The survey results suggest that opioid therapy remains as an important treatment option for chronic malignant and nonmalignant pain. However, the survey results should be viewed in the context of a low response rate (18.2 percent). These results also suggest that by improving the clinical knowledge of physicians participating in opioid therapy through education and collaboration, including a team approach with consultation from pain specialists, psychologists, and others, a better outcome for opioid therapy in patients with chronic pain conditions could be achieved.

Author Biographies

Lucy Chen, MD

MGH Center for Translational Pain Research, Department of Anesthesia and Critical Care, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.

Mary Houghton, BA

MGH Center for Translational Pain Research, Department of Anesthesia and Critical Care, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.

Lindsey Seefeld, BS

MGH Center for Translational Pain Research, Department of Anesthesia and Critical Care, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.

Charlene Malarick, BSN, RN

MGH Center for Translational Pain Research, Department of Anesthesia and Critical Care, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.

Jianren Mao, MD, PhD

MGH Center for Translational Pain Research, Department of Anesthesia and Critical Care, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.

References

U.S. Department of Health and Human Services: Health, United States, 2006 with Chartbook on Trends in the Health of Americans. Washington, DC: U.S. Department of Health and Human Services, 2006: 68.

Ballantyne JC, Mao J: Opioid therapy for chronic pain. N Engl J Med. 2003; 349: 1943-1953.

Upshur CC, Luckmann RS, Savageau JA: Primary care provider concerns about management of chronic pain in community clinic populations. J Gen Intern Med. 2006; 21: 652-655.

Nwokeji ED, Rascati KL, Brown CM, et al.: Influences of attitudes on family physicians’ willingness to prescribe long-acting opioid analgesics for patients with chronic nonmalignant pain. Clin Ther. 2007; 29 (Suppl): 2589-2602.

Lin JJ, Alfandre D, Moore C: Physician attitudes toward opioid prescribing for patients with persistent noncancer pain. Clin J Pain. 2007; 23: 799-803.

Bhamb B, Brown D, Hariharan J, et al.: Survey of select practice behaviors by primary care physicians on the use of opioids for chronic pain. Curr Med Res Opin. 2006; 22: 1859-1865.

Nishimori M, Kulich RJ, Carwood CM, et al.: Successful and unsuccessful outcomes with long-term opioid therapy: A survey of physicians’ opinions. J Palliat Med. 2006; 9: 50-56.

Pletcher MJ, Kertesz SG, Kohn MA, et al.: Trends in opioid prescribing by race/ethnicity for patients seeking care in US emergency departments. JAMA. 2008; 299: 70-78.

Staton LJ, Panda M, Chen I, et al.: When race matters: Disagreement in pain perception between patients and their physicians in primary care. J Natl Med Assoc. 2007; 99: 532-538.

Tamayo-Sarver JH, Dawson NV, Cydulka RK, et al.: Variability in emergency physician decision making about prescribing opioid analgesics. Ann Emerg Med. 2004; 43: 483-493.

Weisse CS, Sorum PC, Sanders KN, et al.: Do gender and race affect decisions about pain management? J Gen Intern Med. 2001; 16: 211-217.

Mao J: Translational pain research: Achievements and challenges. J Pain. 2009; 10: 1001-1011.

Cherny NJ, Chang V, Frager G, et al.: Opioid pharmacotherapy in the management of cancer pain: A survey of strategies used by pain physicians for the selection of analgesic drugs and routes of administration. Cancer. 1995; 76: 1283-1293.

Morley-Forster PK, Clark AJ, Speechley M, et al.: Attitudes toward opioid use for chronic pain: A Canadian physician survey. Pain Res Manag. 2003; 8: 189-194.

Ponte CD, Johnson-Tribino J: Attitudes and knowledge about pain: An assessment of West Virginia family physicians. Fam Med. 2005; 37: 477-480.

Barrett K, Watson A: Physician perspectives on a pilot prescription monitoring program. J Pain Palliat Care Pharmacother. 2005; 19: 5-13.

Potter M, Schafer S, Gonzalez-Mendez E, et al.: Opioids for chronic nonmalignant pain. Attitudes and practices of primary care physicians in the UCSF/Stanford Collaborative Research Network. University of California, San Francisco. J Fam Pract. 2001; 50: 145-151.

Reisfield GM, Wasan AD, Jamison RN: The prevalence and significance of cannabis use in patients prescribed chronic opioid therapy: A review of the extant literature. Pain Med. 2009; 10: 1434-1441.

Fleming MF, Balousek SL, Klessig CL, et al.: Substance use disorders in a primary care sample receiving daily opioid therapy. J Pain. 2007; 8: 573-582.

Manchikanti L, Cash KA, Damron KS, et al.: Controlled substance abuse and illicit drug use in chronic pain patients: An evaluation of multiple variables. Pain Physician. 2006; 9: 215-225.

Fagan MJ, Chen JT, Diaz JA, et al.: Do internal medicine residents find pain medication agreements useful? Clin J Pain. 2008; 24: 35-38.

Touchet BK, Yates WR, Coon KA: Opioid contract use is associated with physician training level and practice specialty. J Opioid Manag. 2005; 1: 195-200.

Furstenberg CT, Ahles TA, Whedon MB, et al.: Knowledge and attitudes of health-care providers toward cancer pain management: A comparison of physicians, nurses, and pharmacists in the state of New Hampshire. J Pain Symptom Manage. 1998; 15: 335-349.

Mortimer JE, Bartlett NL: Assessment of knowledge about cancer pain management by physicians in training. J Pain Symptom Manage. 1997; 14: 21-28.

Reisfield GM, Webb FJ, Bertholf RL, et al.: Family physicians’ proficiency in urine drug test interpretation. J Opioid Manag. 2007; 3: 333-337.

Reisfield GM, Bertholf R, Barkin RL, et al.: Urine drug test interpretation: What do physicians know? J Opioid Manag. 2007; 3: 80-86.

Wilkens JR, Belgrade MJ: Do pain specialists meet the needs of the referring physician? A survey of primary care providers. J Opioid Manag. 2008; 4: 13-20.

Brennan MJ, Stanos S: Strategies to optimize pain management with opioids while minimizing risk of abuse. PM R. 2010; 2: 544-558.

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: 113-130.

Chou R: 2009 Clinical guidelines from the American Pain Society and the American Academy of Pain Medicine on the use of chronic opioid therapy in chronic noncancer pain: What are the key messages for clinical practice? Pol Arch Med Wewn. 2009; 119: 469-477.

Dillman DA, Smyth JD, Christian LM: Internet, Mail and Mixed-Mode Surveys: The Tailored Design Method. 3rd ed. Hoboken, NJ: Wiley, 2009.

Published

01/15/2018

How to Cite

Chen, MD, L., M. Houghton, BA, L. Seefeld, BS, C. Malarick, BSN, RN, and J. Mao, MD, PhD. “Opioid Therapy for Chronic Pain: Physicians’ Attitude and Current Practice Patterns”. Journal of Opioid Management, vol. 7, no. 4, Jan. 2018, pp. 267-76, doi:10.5055/jom.2011.0068.

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Section

Articles