Gaps in Opioid Noncancer Pain Care Pose Risk for Abuse
Gaps in Opioid Noncancer Pain Care Pose Risk for Abuse
September 6, 2012 (Milan, Italy) — Gaps in the primary care management of chronic noncancer pain may be fueling the epidemic in opioid misuse, a new study suggests.
Canadian researchers report that physicians underestimate the prevalence of mixed pain in their patients by more than 25%, and more than 40% do not use standardized pain assessment scales such as the visual analogue scale and the Brief Pain Inventory.
"We want to be very careful about selecting the right patients to be on opioid therapies, and that selection has to be done by careful assessment of history, physical factors, and opioid risk tools...and a lot of that isn't being done," lead investigator Philip Baer, MD, told Medscape Medical News.
Dr. Baer, a rheumatologist in private practice in Scarborough, Ontario, Canada, and editor-in-chief of Journal of the Canadian Rheumatology Association, presented findings here at the International Association for the Study of Pain 14th World Congress on Pain.
Physician and Patient Perspectives
This observational study included surveys of 30 Canadian primary care physicians and 294 of their patients, and was aimed at capturing information on usual patient care visits between May and August of 2011.
The surveys covered patient demographics and social history, medical history, pain assessment, and therapeutic goals, explained Dr. Baer. Mirror questions in the surveys facilitated comparison between physicians' perceptions of their practice profile and patients' perspectives.
Most physicians (63%) had practiced for longer than 20 years, said Dr. Baer.
Almost half (47%) were family/general practitioners with a special interest in pain management, another 33% were family/general practitioners, and 13% were pain management specialists.
Patients were fairly evenly divided between male (55%) and female, with 33% on long-term disability, 30% working full time, 14% retired, and 5% on short-term disability.
Relevant comorbid conditions included sleep disorders (57%), depression (49%), obesity (30%), cardiovascular disease (21%), other mood disorders/psychiatric conditions (18%), substance abuse disorders (11%), and impaired renal function (3%).
The study found that 54% of physicians used the visual analogue scale to assess patients' pain, and 58% used the standardized Brief Pain Inventory.
At baseline, physicians estimated that 24% of patients had nociceptive pain, 19% had neuropathic pain, and 38% had mixed pain. However, patient assessments showed that almost twice as many patients (65%) had mixed pain than had been estimated, and "the majority of patients were prescribed more than one medication for pain, suggesting that Canadian physicians are treating for a mixed etiology without acknowledging it as such," the authors note in the poster.
Researchers found that use of nonpharmacologic therapies was low, and pharmacologic therapies, including short-acting opioids (57%), long-acting opioids (65%), antidepressants (49%), and anticonvulsants (30%), were used most often.
Vital to Effective Treatment
Study findings show a gap in assessment vs treatment of pain, Dr. Baer concluded.
"The classification of chronic pain as nociceptive, neuropathic, or mixed in origin can be vital to effective treatment, since patients with one type of pain may be resistant to therapies that are effective in other types," the authors write.
"It looks like in practice, people are not doing a systematic assessment, and therefore people are getting on opioids who shouldn't be, and we are seeing more of the problems that, with more careful selection, we wouldn't have," he said.
Lynn Webster, MD, president-elect of the American Academy of Pain Medicine, told Medscape Medical News that although the use of risk assessment guidelines is considered the standard of care in the United States, "it is likely that some physicians could do a better job of assessing who should or should not receive opioids."
"This is a complicated area of medicine and requires vigilance for patient and community safety," added Dr. Webster, who is medical director of the Lifetree Clinical Research and Pain Clinic, in Salt Lake City, Utah.
The study was funded by Janssen Inc. Dr. Webster has disclosed that he self-funded the development of the Opioid Risk Tool, which is a recommended tool in both US and Canadian guidelines. The speakers have disclosed no relevant financial relationships.
International Association for the Study of Pain 14th World Congress on Pain. Abstract PH 021. Presented August 30, 2012.
September 6, 2012 (Milan, Italy) — Gaps in the primary care management of chronic noncancer pain may be fueling the epidemic in opioid misuse, a new study suggests.
Canadian researchers report that physicians underestimate the prevalence of mixed pain in their patients by more than 25%, and more than 40% do not use standardized pain assessment scales such as the visual analogue scale and the Brief Pain Inventory.
"We want to be very careful about selecting the right patients to be on opioid therapies, and that selection has to be done by careful assessment of history, physical factors, and opioid risk tools...and a lot of that isn't being done," lead investigator Philip Baer, MD, told Medscape Medical News.
Dr. Baer, a rheumatologist in private practice in Scarborough, Ontario, Canada, and editor-in-chief of Journal of the Canadian Rheumatology Association, presented findings here at the International Association for the Study of Pain 14th World Congress on Pain.
Physician and Patient Perspectives
This observational study included surveys of 30 Canadian primary care physicians and 294 of their patients, and was aimed at capturing information on usual patient care visits between May and August of 2011.
The surveys covered patient demographics and social history, medical history, pain assessment, and therapeutic goals, explained Dr. Baer. Mirror questions in the surveys facilitated comparison between physicians' perceptions of their practice profile and patients' perspectives.
Most physicians (63%) had practiced for longer than 20 years, said Dr. Baer.
Almost half (47%) were family/general practitioners with a special interest in pain management, another 33% were family/general practitioners, and 13% were pain management specialists.
Patients were fairly evenly divided between male (55%) and female, with 33% on long-term disability, 30% working full time, 14% retired, and 5% on short-term disability.
Relevant comorbid conditions included sleep disorders (57%), depression (49%), obesity (30%), cardiovascular disease (21%), other mood disorders/psychiatric conditions (18%), substance abuse disorders (11%), and impaired renal function (3%).
The study found that 54% of physicians used the visual analogue scale to assess patients' pain, and 58% used the standardized Brief Pain Inventory.
At baseline, physicians estimated that 24% of patients had nociceptive pain, 19% had neuropathic pain, and 38% had mixed pain. However, patient assessments showed that almost twice as many patients (65%) had mixed pain than had been estimated, and "the majority of patients were prescribed more than one medication for pain, suggesting that Canadian physicians are treating for a mixed etiology without acknowledging it as such," the authors note in the poster.
Researchers found that use of nonpharmacologic therapies was low, and pharmacologic therapies, including short-acting opioids (57%), long-acting opioids (65%), antidepressants (49%), and anticonvulsants (30%), were used most often.
Vital to Effective Treatment
Study findings show a gap in assessment vs treatment of pain, Dr. Baer concluded.
"The classification of chronic pain as nociceptive, neuropathic, or mixed in origin can be vital to effective treatment, since patients with one type of pain may be resistant to therapies that are effective in other types," the authors write.
"It looks like in practice, people are not doing a systematic assessment, and therefore people are getting on opioids who shouldn't be, and we are seeing more of the problems that, with more careful selection, we wouldn't have," he said.
Lynn Webster, MD, president-elect of the American Academy of Pain Medicine, told Medscape Medical News that although the use of risk assessment guidelines is considered the standard of care in the United States, "it is likely that some physicians could do a better job of assessing who should or should not receive opioids."
"This is a complicated area of medicine and requires vigilance for patient and community safety," added Dr. Webster, who is medical director of the Lifetree Clinical Research and Pain Clinic, in Salt Lake City, Utah.
The study was funded by Janssen Inc. Dr. Webster has disclosed that he self-funded the development of the Opioid Risk Tool, which is a recommended tool in both US and Canadian guidelines. The speakers have disclosed no relevant financial relationships.
International Association for the Study of Pain 14th World Congress on Pain. Abstract PH 021. Presented August 30, 2012.
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