BOSTON – The discomfort among primary care physicians managing patients on opioids is not necessarily mitigated with greater support from pain specialists, according to a study that tracked attitudes before and after an initiative specifically designed to increase that support.

The study, presented at the International Conference on Opioids, surveyed 56 primary care clinicians before and after the initiative, according to Robert Jamison, Ph.D., professor in the departments of anesthesia, psychiatry, and physician medicine and rehabilitation at Harvard Medical School in Boston.

The study, according to Dr. Jamison, was based on the observation that primary care physicians are uncomfortable prescribing opioids even after a pain specialist has recommended this therapy.

“A lot of primary care physicians don’t like pain specialists,” Dr. Jamison said. The reason, he explained, is that they are uncomfortable prescribing or managing opioids in patients with chronic pain, and they think that pain specialists provide them with little support.

In a study that involved 56 primary care physicians and 253 chronic pain patients that they referred, a baseline survey showed that less than 20% of the physicians reported formal training in pain management. In addition, 80% reported that they considered treating chronic pain to be a challenge, and nearly 70% reported that they feared prescribing opioids because of the risk of addiction. In addition, 62.5% reported that they were dissatisfied with their past consults with pain specialists.

After the survey, a program was initiated to provide support for opioid management in the referred chronic pain patients. This involved evaluating and initiating a pain management program that included screening patients for risk of opioid misuse. Although all the patients were potential candidates for opioids based on clinical characteristics, only 207 ultimately received opioids.

With patient management, the program also provided the participating primary care physicians with guidance on managing chronic pain with opioids.

The chronic pain patients were contacted monthly by telephone to evaluate compliance and risk of opioid misuse. Follow-up was maintained over 6 months. The 33 primary care physicians linked to the Harvard electronic medical records system were provided with monthly status reports about the opioid patients in their care.

When the primary care physicians were surveyed at the end of 6 months, there was essentially no change in attitude in regard to the challenges of managing patients on opioids, including fear of patient addiction or the physician’s confidence in his or her ability to identify patients at risk of addiction.

Physicians did, however, express improved sense of support from pain specialists. For example, the initial 62.5% rate of dissatisfaction with communication with pain specialists fell to 23.4%. In addition, physician comfort with opioids more than tripled, rising from 7.2% to 23.4%. However, this suggested that 75% of physicians were still uncomfortable.

“So we did get some mixed results on our intervention,” acknowledged Dr. Jamison, who noted that the data from this recently completed study are still being analyzed. He did note that satisfaction overall with pain-specialist communication was greatest in those physicians who received monthly reports.

Based on the data analyzed to date, the findings might be best interpreted “as a heads-up for pain specialists in the room to say that primary care physicians don’t feel that they are getting the support that they need,” Dr. Jamison reported.

The study was investigator initiated. Dr. Jamison reported having no financial disclosures.


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