scholarly journals Self-Reported Practices in Opioid Management of Chronic Noncancer Pain: A Survey of Canadian Family Physicians

2013 ◽  
Vol 18 (4) ◽  
pp. 177-184 ◽  
Author(s):  
Michael JM Allen ◽  
Mark M Asbridge ◽  
Peter C MacDougall ◽  
Andrea D Furlan ◽  
Oleg Tugalev
Keyword(s):  
Medical Education ◽  
Online Survey ◽  
Monitoring Program ◽  
Family Physicians ◽  
Precautionary Approach ◽  
Chronic Noncancer Pain ◽  
Canadian Guideline ◽  
Prescription Monitoring ◽  
Daily Dose ◽  
Noncancer Pain

BACKGROUND: In May 2010, a new Canadian guideline on prescribing opioids for chronic noncancer pain (CNCP) was released. To assess changes in family physicians’ (FPs) prescribing of opioids following the release of the guideline, it is necessary to know their practices before the guideline was widely disseminated.OBJECTIVES: To determine FPs’ practices and knowledge in prescribing opioids for CNCP in relation to the Canadian guideline, and to determine factors that hinder or enable FPs in prescribing opioids for CNCP.METHODS: An online survey was developed and FPs who manage CNCP were electronically contacted through the College of Family Physicians of Canada, university continuing medical education offices and provincial regulatory colleges.RESULTS: A total of 710 responses were received. FPs followed a precautionary approach to prescribing opioids and already practiced in accordance with Canadian guideline recommendations by discussing adverse effects, monitoring for aberrant drug-related behaviour and advising caution when driving. However, FPs seldom discontinued opioids even if they were ineffective and were unaware of the ‘watchful dose’ of opioids, the daily dose at which patients may need reassessment or closer monitoring. Only two of nine knowledge questions were answered correctly by more than 40% of FPs. The main enabler to optimal opioid prescribing was having access to a patient’s opioid history from a provincial prescription monitoring program. The main barriers to optimal prescribing were concerns about addiction and misuse.CONCLUSIONS: While FPs follow a precautionary approach to prescribing opioids for CNCP, there are substantial practice and knowledge gaps, with implications for patient safety and costs.

scholarly journals Perceptions and Impact of the 2017 Canadian Guideline for Opioid Therapy and Chronic Noncancer Pain: A Cross-Sectional Study of Canadian Physicians

2020 ◽  
Vol 2020 ◽  
pp. 1-6
Author(s):  
Jason W. Busse ◽  
Joyce Douglas ◽  
Tara S. Chauhan ◽  
Bilal Kobeissi ◽  
Jeff Blackmer
Keyword(s):  
Online Survey ◽  
Preliminary Evidence ◽  
Opioid Therapy ◽  
Cross Sectional Study ◽  
High Dose ◽  
Cross Sectional ◽  
Chronic Noncancer Pain ◽  
Canadian Guideline ◽  
Opioid Tapering ◽  
Noncancer Pain

Background. Physician adherence to guideline recommendations for the use of opioids to manage chronic pain is often limited. Objective. In February 2018, we administered a 28-item online survey to explore perceptions of the 2017 Canadian guideline for opioid therapy and chronic noncancer pain and if physicians had altered practices in response to recommendations. Results. We invited 34,322 Canadian physicians to complete our survey, and 1,128 responded for a response rate of 3%; 687 respondents indicated they prescribed opioids for noncancer pain and answered survey questions about the guideline and their practice. Almost all were aware of the guideline, 94% had read the document, and 89% endorsed the clarity as good or excellent. The majority (86%) felt the guideline was feasible to implement, but 66% highlighted resistance by patients, and 63% the lack of access to effective nonopioid treatment as barriers. Thirty-six percent of respondents mistakenly believed the guideline recommended mandatory tapering for patients using high-dose opioid therapy (≥90 mg morphine equivalent per day), and 58% felt they would benefit from support for opioid tapering. Seventy percent of respondents had changed practices to align with guideline recommendations, with 51% engaging some high-dose patients in opioid tapering and 43% reducing the number of new opioid starts. Conclusion. There was high awareness of the 2017 Canadian opioid guideline among respondents, and preliminary evidence that recommendations have changed practice to better align with the evidence. Ongoing education is required to avoid the misunderstanding that opioid tapering is mandatory, and research to identify effective strategies to manage chronic noncancer pain is urgently needed.

scholarly journals Opioid Prescribing Practices and Training Needs of Québec Family Physicians for Chronic Noncancer Pain

2017 ◽  
Vol 2017 ◽  
pp. 1-10 ◽  
Author(s):  
Élise Roy ◽  
Richard J. Côté ◽  
Denis Hamel ◽  
Pierre-André Dubé ◽  
Éric Langlois ◽  
...  
Keyword(s):  
Online Survey ◽  
Family Physicians ◽  
Training Needs ◽  
Opioid Use ◽  
Prescribing Practices ◽  
Opioid Prescription ◽  
Chronic Noncancer Pain ◽  
Pain Syndromes ◽  
Noncancer Pain ◽  
And Training

Aim. To examine medical practices and training needs of Québec family physicians with respect to pain management and opioid prescription for chronic noncancer pain (CNCP). Methodology. An online survey was carried out in 2016. Results. Of 636 respondents (43.0% men; 54.3% ≥ 50 years old), 15.2% and 70.9% felt very or somewhat confident that they could properly prescribe opioids for CNCP. Concerns related to abuse (72.5% strongly/somewhat agree), dependence (73.2%), and lack of support (75.4%) were the main barriers reported. Only 19.7% always/often screened their patients for risks of abuse and dependence using a screening tool. About two-thirds of participants (65.7%) had recently (last five years) taken part in continuing education programs on opioid use for CNCP and 73.4% on CNCP management. Patient evaluation and differential diagnoses of chronic pain syndromes were rated as a top priority for further training. Conclusions. This study provides insights into Québec family physicians’ concerns, practices, and needs with respect to the management of CNCP. Physicians’ difficulties around the application of strategies to mitigate the problem of opioid abuse and addiction are worrying. The need to better train physicians in the field of pain and addiction cannot be emphasized enough.

scholarly journals Self-Reported Practices in Opioid Management of Chronic Noncancer Pain: An Updated Survey of Canadian Family Physicians

2020 ◽  
Vol 9 (10) ◽  
pp. 3304
Author(s):  
Andrea D. Furlan ◽  
Santana Diaz ◽  
Angela Carol ◽  
Peter MacDougall ◽  
Michael Allen
Keyword(s):  
Online Survey ◽  
Family Physicians ◽  
Opioid Therapy ◽  
Chronic Noncancer Pain ◽  
Barriers And Enablers ◽  
Canadian Population ◽  
Noncancer Pain ◽  
Morphine Equivalent ◽  
Main Factor

Chronic pain affects one in five Canadians, and opioids continue to be prescribed to 12.3% of the Canadian population. A survey of family physicians was conducted in 2010 as a baseline prior to the release of the Canadian Opioid Guideline. We repeated the same survey with minor modifications to reflect the updated 2017 opioid prescribing guideline. The online survey was distributed in all provinces and territories in both English and French. There were 265 responses from May 2018 to October 2019, 55% of respondents were male, 16% had advanced training in pain management, 51% had more than 20 years in practice, 54% wrote five or fewer prescriptions of opioids per month, and 58% were confident in their skills in prescribing opioids. Of the 11 knowledge questions, only two were correctly selected by more than 80% of the respondents. Twenty-nine physicians (11%) do not prescribe opioids, and the main factor affecting their decisions were concerns about long-term adverse effects and lack of evidence for effectiveness of opioids in chronic noncancer pain. Of the 12 guideline-concordant practices, only two were performed regularly by 90% or more of the respondents: explain potential harms of long-term opioid therapy and beginning dose of less than 50 mg of morphine equivalent daily. This survey represents a small proportion of family physicians in Canada and its generalizability is limited. However, we identified a number of opioid-related and guideline-specific gaps, as well as barriers and enablers to prescribing opioids and adhering to the guideline.

Attributes, Attitudes, and Practices of Clinicians Concerned with Opioid Prescribing

Pain Medicine ◽  
2018 ◽  
Vol 20 (10) ◽  
pp. 1934-1941 ◽  
Author(s):  
Zayd Razouki ◽  
Bushra A Khokhar ◽  
Lindsey M Philpot ◽  
Jon O Ebbert
Keyword(s):  
Monitoring Program ◽  
Program Review ◽  
Opioid Misuse ◽  
Opioid Use ◽  
Prescribing Practices ◽  
Chronic Noncancer Pain ◽  
Opioid Prescribing ◽  
Attitudes And Practices ◽  
Urine Drug ◽  
Noncancer Pain

Abstract Background Many clinicians who prescribe opioids for chronic noncancer pain (CNCP) express concerns about opioid misuse, addiction, and physiological dependence. We evaluated the association between the degree of clinician concerns (highly vs less concerned), clinician attributes, other attitudes and beliefs, and opioid prescribing practices. Methods A web-based survey of clinicians at a multispecialty medical practice. Results Compared with less concerned clinicians, clinicians highly concerned with opioid misuse, addiction, and physiological dependence were more confident prescribing opioids (risk ratio [RR] = 1.34, 95% confidence interval [CI] = 1.08–1.67) but were more reluctant to do so (RR = 1.13, 95% CI = 1.03–1.25). They were more likely to report screening patients for substance use disorder (RR = 1.18, 95% CI = 1.01–1.37) and to discontinue prescribing opioids to a patient due to aberrant opioid use behaviors (RR = 1.30, 95% CI = 1.13–1.50). They were also less likely to prescribe benzodiazepines and opioids concurrently (RR = 0.40, 95% CI = 0.25–0.65). Highly concerned clinicians were more likely to work in clinics which engage in “best practices” for opioid prescribing requiring urine drug screening (RR = 4.65, 95% CI = 2.51–8.61), prescription monitoring program review (RR = 2.90, 95% CI = 1.84–4.56), controlled substance agreements (RR = 4.88, 95% CI = 2.64–9.03), and other practices. Controlling for clinician concern, prescribing practices were also associated with clinician confidence, reluctance, and satisfaction. Conclusions Highly concerned clinicians are more confident but more reluctant to prescribe opioids. Controlling for clinician concern, confidence in care and reluctance to prescribe opioids were associated with more conservative prescribing practices.

Attitudes toward the Canadian Guideline for Safe and Effective Use of Opioids for Chronic Non-Cancer Pain: A qualitative study

2016 ◽  
Vol 12 (6) ◽  
pp. 377 ◽  
Author(s):  
Yaping Chang, MSc ◽  
Kan Lun Zhu ◽  
Ivan D. Florez, MD, MSc ◽  
Sung Min Cho, BHSc ◽  
Nasim Zamir, HBSc ◽  
...  
Keyword(s):  
Qualitative Study ◽  
Specific Therapy ◽  
Chronic Noncancer Pain ◽  
Canadian Guideline ◽  
Positive Attitudes ◽  
Semistructured Interviews ◽  
Urine Drug ◽  
Noncancer Pain ◽  
Effective Use ◽  
Morphine Equivalent

Background: Chronic noncancer pain (CNCP) refers to all pain disorders, not due to cancer, that persist for ≥3 months. The point prevalence of CNCP in the general population of Western countries is between 19 and 33 percent. Opioids are commonly prescribed for CNCP and are associated with both benefits and harms. The Canadian Guideline for Safe and Effective Use of Opioids for CNCP was published in 2010 to provide guidance for optimal opioid prescribing in patients with CNCP.Objectives: To investigate the attitudes toward, and use of, the Canadian Opioids Guideline among pain physicians.Design: A qualitative study using one-on-one, semistructured interviews with 12 pain physicians in Ontario, Canada, and thematic analysis of verbatim transcripts.Results: Major themes that emerged from interviews included: (1) generally positive attitudes toward the 2010 Canadian Opioids Guideline, but limited use—half (six of 12) reported they did not use the guideline in practice; (2) strongly contrasting views regarding the 200 mg/d morphine equivalent watchful dose; (3) recognition of gaps in the guideline, especially recommendations for urine drug screening and pain severity-specific therapy; (4) the guideline is excessively long and the format suboptimal; and (5) improved dissemination and education are needed to enhance guideline uptake.Conclusions: Despite its merits, the Canadian Opioids Guideline suffers from information gaps and from limited uptake, at least in part due to suboptimal format and suboptimal dissemination.

scholarly journals The authors respond to “Inconsistencies in the 2017 Canadian Guideline for Opioids for Chronic Noncancer Pain”

2017 ◽  
Vol 189 (39) ◽  
pp. E1234-E1235 ◽  
Author(s):  
Jason W. Busse ◽  
David N. Juurlink ◽  
D. Norman Buckley ◽  
Gordon H. Guyatt
Keyword(s):  
Chronic Noncancer Pain ◽  
Canadian Guideline ◽  
Noncancer Pain

scholarly journals Preparation, Confidence, and Attitudes About Chronic Noncancer Pain in Graduate Medical Education

2010 ◽  
Vol 2 (2) ◽  
pp. 260-268 ◽  
Author(s):  
Leanne M. Yanni ◽  
Jessica L. McKinney-Ketchum ◽  
Sarah B. Harrington ◽  
Christine Huynh ◽  
Saad Amin, BS ◽  
...  
Keyword(s):  
Medical Education ◽  
Pain Management ◽  
Medical School ◽  
Graduate Medical Education ◽  
Clear Understanding ◽  
Education Programs ◽  
Chronic Noncancer Pain ◽  
Roles And Responsibilities ◽  
Graduate Medical ◽  
Noncancer Pain

Abstract Background Physicians report they feel ill-prepared to manage chronic noncancer pain (CNCP), in part because of inadequate training. Published studies and clinical observation demonstrate that trainees lack confidence and reflect negative attitudes about CNCP. Overall, there is minimal published guidance on specific specialty roles and responsibilities in CNCP management. Objective The purpose of this study was to assess resident preparation, confidence, and attitudes about CNCP across graduate medical education programs and to assess resident perception of roles and responsibilities in CNCP management. Methods In 2006 we surveyed residents from 13 graduate medical education programs in 3 institutions about CNCP and report quantitative and qualitative analyses of survey responses from 246 respondents. Results A total of 59% of respondents rated their medical school preparation and 36% rated their residency preparation as “fair” or “poor”; only 17% reported being “confident” or “very confident” in assessing patients with CNCP; and 30% used negative or derogatory terms (eg, manipulative, irritable, needy) to describe patients with CNCP. Respondents from postgraduate years 3–6 were more than twice as likely as postgraduate year 1 or postgraduate year 2 respondents (44% versus 21% and 20%, respectively) to use negative or derogatory terms (P  =  .0007). Respondents were significantly more likely to report that pain specialists are “good” or “excellent” in managing CNCP compared with generalists (73% versus 6%; P < .0001). Conclusion Education in pain management should begin in medical school and continue through graduate medical education, regardless of specialty. Early and sustained training interventions are needed to foster empathy in caring for patients with pain. Residency and fellowhip training should impart a clear understanding of each specialty's role and responsibilities in pain management to better foster patient-centered pain care.

Factors associated with participation and nonparticipation in a VA Whole Health Primary Care Pain Education and Opioid Monitoring Program (PC-POP)

2020 ◽  
Vol 16 (3) ◽  
pp. 179-188
Author(s):  
Amber Martinson, PhD ◽  
Amanda Kutz, PhD ◽  
William Marchand, MD ◽  
Julie Carney, RN ◽  
Jamie Clinton-Lont, MS, CNP
Keyword(s):  
Mental Health ◽  
Primary Care ◽  
Rural Areas ◽  
Monitoring Program ◽  
Primary Care Providers ◽  
Care Providers ◽  
Pain Education ◽  
Chronic Noncancer Pain ◽  
Medical Diagnoses ◽  
Noncancer Pain

Objective: As part of the evaluation of the Whole Health Primary Care Pain Education and Opioid Monitoring Program (PC-POP), we compared demographic and health characteristics between participants and nonparticipants drawn from the same defined population.Design/Methods: Retrospective chart review comparing participants and nonparticipants in terms of two categories of variables: (1) demographic characteristics and (2) physical/mental health characteristics.Setting: VA Primary Care.Subjects: Adult veterans with chronic noncancer pain receiving opioid therapy 3 months being managed in primary care.Results: A total of 749 veterans (424 participants in PC-POP and 325 nonparticipants) were included in the final analysis. Results showed that nonparticipation was associated with more widespread musculoskeletal pain, low back pain, anxiety, higher mortality, and rural areas. Participation was associated with more medical diagnoses overall, hypertension, sleep apnea, fibromyalgia, peripheral nerve pain, depression, and female gender. Other demographic and physical/mental health variables did not significantly differ between the groups.Conclusions: Given that primary care is the dominant healthcare setting in which opioids are prescribed for chronic noncancer pain, programs are needed to assist primary care providers to meet the rigorous requirements of guideline concordant care. The current study examined participation factors in such a program and found that certain veterans were less likely to participate than others. Identifying such veterans at the outset, in combination with intentional recruitment efforts and individualized interventions, may promote entry into PC-POP.

Examining the relationship between pain interference, pain intensity, and mental health symptoms among veterans receiving long-term opioid therapy for chronic noncancer pain in primary care

2021 ◽  
Vol 17 (4) ◽  
pp. 289-299
Author(s):  
Amanda Kutz, PhD ◽  
Amber Martinson, PhD ◽  
Katherine Stratton, PsyD ◽  
Clayton Hamilton, PharmD ◽  
Julie Carney, RN ◽  
...  
Keyword(s):  
Mental Health ◽  
Primary Care ◽  
Pain Intensity ◽  
Monitoring Program ◽  
Opioid Therapy ◽  
Pain Interference ◽  
Chronic Noncancer Pain ◽  
Noncancer Pain ◽  
The Relationship

Objective: As part of the evaluation of the Whole Health Primary Care Pain Education and Opioid Monitoring Program (PC-POP), we examined the relationship between pain intensity, pain interference, and mental health symptoms among PC-POP enrollees.Design/methods: Retrospective cohort study examining self-reported symptoms of pain intensity, pain interference, anxiety, depression, substance use, and quality of life. Data were retrieved through a combination of chart review and data extracted from the VA Informatics and Computing Infrastructure. Setting: Veterans Health Administration Health Care System Primary Care service.Subjects: Adult veterans with chronic noncancer pain receiving opioid therapy 3 months being managed in primary care and enrolled in PC-POP between August 1, 2018 and April 1, 2019.Results: A total of 439 participants were included in the final analysis. Results showed that anxiety has a unique relationship to pain intensity and that depression and quality of life have unique relationships to pain interference when relevant covariates, eg, gender, age, pain diagnosis, and predictors are examined among this unique sample of veterans enrolled in a pain and opioid education and monitoring program.Conclusions: Given that primary care is the dominant healthcare setting in which opioids are prescribed for chronic noncancer pain, further research is needed to examine factors that influence pain management in this setting. This study examined the role mental health factors have on pain intensity and pain interference among patients enrolled in an opioid monitoring program and found that anxiety and depression appear to uniquely predict how intensely and impactful these veterans experience their pain. This study extends the literature by examining such factors among a unique population that has yet to be studied and offers some recommendations for monitoring and practice.

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