Successful and unsuccessful outcomes with long-term opioid therapy: a survey of physicians' opinions.
BACKGROUND
The attitudes, beliefs, and experience of physicians will influence how they view the use of opioids for chronic nonterminal pain.


OBJECTIVE
To survey pain specialists and primary care providers (PCPs) to obtain their opinion and attitude on aberrant drug-taking behaviors.


METHODS
We surveyed three physician groups, mailing 250 surveys followed by two followups. The survey consisted of (1) questions about beliefs in the effectiveness of long-term opioid therapy and successful and unsuccessful outcomes and (2) a ratings section for possible indicators of unsuccessful long-term opioid treatment.


RESULTS
In total 147 questionnaires (82 PCPs, 65 pain specialists) were returned. Pain specialists reported a greater number of patients undergoing long-term opioid therapy compared to nonpain specialists. Opinion regarding the effectiveness of long-term opioid therapy among all physicians was mixed but there was no significant difference between pain specialists and PCPs. There was agreement among physicians with regard to highly aberrant behaviors being indicators of failed long-term opioid therapy. The ratings of the following indicators showed differences between each group: no improvement in pain control, not being able to return to work, and a deterioration in relationships with others. Physicians reported increases or decreases in function to be the most important successful or unsuccessful outcome, respectively.


CONCLUSIONS
This preliminary survey showed consensus among physicians that highly aberrant behaviors indicate a failure of chronic opioid therapy. However, when considering less egregious behaviors, it would appear a physician's experience and the number of patients they had taking opioids influenced their opinion.
Nishimori
Mina
M
The MGH Pain Center, Department of Anesthesia and Critical Care, Massachusetts General Hospital and Harvard Medical School, Boston Massachusetts 02114, USA. mnishimori@partners.org
Kulich
Ronald J
RJ
Carwood
Caroline M
CM
Okoye
Vivienne
V
Kalso
Eija
E
Ballantyne
Jane C
JC
D000701:Analgesics, Opioid / Q000008:administration & dosage*; D016009:Chi-Square Distribution; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D017063:Outcome Assessment, Health Care; D010146:Pain / Q000188:drug therapy*; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D018709:Statistics, Nonparametric; D011795:Surveys and Questionnaires
D000701:Analgesics, Opioid