Do pain specialists meet the needs of the referring physician? A survey of primary care providers

Jane R. Wilkens, MD; Miles J. Belgrade, MD

doi:10.5055/jom.2008.0003

Authors

Jane R. Wilkens, MD
Miles J. Belgrade, MD

DOI:

https://doi.org/10.5055/jom.2008.0003

Keywords:

opioids, primary care, chronic noncancer pain, trilateral agreement

Abstract

Objective: To study the factors that influence the use of opioids in the management of chronic noncancer pain (CNCP) by primary care providers (PCPs) for patients returning from a pain specialist.
Design: A survey of PCPs.
Setting: Two physician groups in the Minneapolis-St. Paul metropolitan area.
Participants: Two seventy-six PCPs surveyed and 80 surveys returned.
Main outcome measures: Participants rated the importance of specific concerns regarding the role of pain specialists and the use of opioids in the management of CNCP. Past experience with pain specialists, comfort using opioids, and opinions regarding a trilateral opioid agreement were also examined.
Results: The top concerns for PCPs were as follows: the use of opioids in patients with chemical dependency or psychological issues, the escalation of opioid dosing, and the use of opioids in pain states without objective findings. They also ranked highly the importance of coordinating the return of patients from a pain specialist with explicit opioid instructions and the availability of consultation by phone or a timely follow-up visit. PCPs were supportive of the concept of a trilateral opioid agreement.
Conclusions: PCPs have significant concerns regarding the prescribing of opioids in CNCP. They desire closer collaboration with pain specialists, including more explicit plans of care when patients are transferred back to them. The trilateral agreement may provide one framework for better collaboration.

Author Biographies

Jane R. Wilkens, MD

Department of Pain Management, Stillwater Medical Group, Stillwater, Minnesota.

Miles J. Belgrade, MD

Fairview Pain and Palliative Care Center, University of Minnesota Medical Center, Minneapolis, Minnesota.

References

Eriksen J, Sjøgren P, Bruera E, et al.: Critical issues on opioids in chronic non-cancer pain: An epidemiological study. Pain. 2006; 125: 172-179.

Belgrade MJ, Schamber CD, Lindgren BR: The DIRE score: Predicting outcomes of opioid prescribing for chronic pain. J Pain. 2006; 7(9): 671-681.

Webster LR, Webster RM: Predicting aberrant behaviors in opioid-treated patients: Preliminary validation of the opioid risk tool. Pain Med. 2005; 6(6): 432-442.

Passik SD, Kirsh KL, Whitcomb L, Portenoy RK, et al.: A new tool to assess and document outcomes in chronic pain patients receiving opioid therapy. Clin Ther. 2004; 26: 552-561.

Adams LL, Gatchel RJ, Robinson RC, et al.: Development of a self-report screening instrument for assessing potential opioid medication misuse in chronic pain patients. J Pain Symptom Manag. 2004; 27(5): 440-459.

Fishman S, Mahajan G, Jung S, et al.: The trilateral opioid contract: Bridging the pain clinic and the primary care physician through the opioid contract. J Pain Symptom Manag. 2002; 24: 335-344.

Reid MC, Engles-Horton L, Weber M, et al.: Use of opioid medications for chronic noncancer pain syndromes in primary care. J Gen Intern Med. 2002; 17: 173-179.

Ponte C, Johnson-Tribino J: Attitudes and knowledge about pain: An assessment of West Virginia family physicians. Family Med. 2005; 37(7): 477-480.

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

Adams N, Plane MB, Fleming M, et al.: Opioids and the treatment of chronic pain in a primary care sample. J Pain Symptom Manag. 2001; 22: 791-796.

McCracken L, Velleman S, Eccelston C: Patterns of use and concern about opioid analgesia for chronic nonmalignant pain in general practice: A survey of physicians. American Pain Society Annual Meeting 2007, Washington, DC, Poster No. 814.

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. J Fam Pract. 2001; 50(2): 145-151.

Bendtsen P, Hensing G, Ebeling C, et al.: What are the dilemmas experienced when prescribing opioids in general practice? Pain. 1999; 82: 89-96.

Hutchinson K, Moreland A, Williams A, et al.: Exploring beliefs and practice of opioid prescribing for persistent noncancer pain by general practitioners. Eur J Pain. 2007; 11: 93-98.

Tafor S, Kern T, Oswalt K: Primary care physician attitudes toward managing patients with chronic pain. American Pain Society Annual Meeting 2007, Washington, DC, Poster #930.

Becker N, Sjogren P, Bech P, et al.: Treatment outcome of chronic non-malignant pain patients managed in a Danish multidisciplinary pain centre compared to general practice: A randomised controlled trial. Pain. 2000; 84: 203-211.

Donner B, Raber M, Zenz M, et al.: Experiences with the prescription of opioids: A patient questionnaire. J Pain Symptom Manag. 1998; 15: 231-235.