Evaluation of Primary Care Physician Chronic Pain Management Practice Patterns

Background: The management of chronic pain is complex and often involves the integration of multiple clinical, humanistic, and economic factors. Primary care physicians (PCPs) are often at the forefront of managing chronic pain and often initiate pharmacological pain management therapy. To date little is known surrounding the pain management practices of PCPs. Objective: The purpose of this study is to assess the knowledge and practice of PCPs in management of chronic pain. Study Design: A survey. Setting: Western region of Pennsylvania, US. Methods: A cross-sectional questionnaire survey evaluated PCPs pain management treatment practices including assessment of chronic pain, procedural activities surrounding therapy, decision-making input, and knowledge for therapeutic pain management including the 5 main classes of medications. The questionnaire was developed based on a review of the literature including published chronic pain guidelines. The questionnaire was mailed to a convenience sample of 300 PCPs practicing in Western Pennsylvania. The study was approved by the University Institutional Review Board. Results: The survey had a response rate of 16%. The respondents on average treated 30 chronic pain patients per month predominately in a community setting. The most common conditions treated included osteoarthritis, back and neuropathic pain. Although the major reported source of education was published literature, only 67% respondents referred to pain management guidelines. Multiple knowledge and practice gaps were identified surrounding pharmacological treatment, medication management including compliance practices, and pain assessment. Limitations: Although low, the response rate is comparable to response rates for other chronic pain management topics including anticoagulation and prescription patterns for chronic pain physicians. Also, greater than 50% of the respondents were from private practice, therefore, the results may not pertain to other practice settings including academic and hospital-based practices. Conclusions: The survey provided significant insight into PCP practices and highlights areas for future educational efforts. Further opioid prescribing education would be beneficial especially regarding the utilization of opioid risk assessment tools, the selection of opioids, and opioid end organ effects. Furthermore, patient education on the realities of chronic pain management and the importance of nonpharmacological treatment are needed in order to reduce the challenges faced by PCPs surrounding chronic pain management. Key words: Chronic pain, primary care physician, pain management, survey questionnaire