Primary care provider concerns about management of chronic pain in community clinic populations.
BACKGROUND
Chronic pain is a common patient complaint in primary care, yet providers and patients are often dissatisfied with treatment processes and outcomes.


OBJECTIVE
To assess provider satisfaction with their training for and current management of chronic pain in community clinic settings. To identify perceived problems with delivering chronic pain treatment and issues with opioid prescribing for chronic pain.


METHODS
Mailed survey to primary care providers (PCPs) at 8 community clinics.


RESULTS
Respondents (N=111) included attendings, residents, and nurse practioners (NPs)/physician assistants (PAs). They reported 37.5% of adult appointments in a typical week involved patients with chronic pain complaints. They attributed problems with pain care and opioid prescribing more often to patient-related factors such as lack of self-management, and potential for abuse of medication than to provider or practice system factors. Nevertheless, respondents reported inadequate training for, and low satisfaction with, delivering chronic pain treatment.


CONCLUSIONS
A substantial proportion of adult primary care appointments involve patients with chronic pain complains. Dissatisfaction with training and substantial concerns about patient self-management and about opioid prescribing suggest areas for improving medical education and postgraduate training. Emphasis on patient-centered approaches to chronic pain management, including skills for assessing risk of opioid abuse and addiction, is required.
Upshur
Carole C
CC
Department of Family Medicine and Community Health, University of Massachusetts Medical School, Worcester, MA, USA. Carole.upshur@umassmed.edu
Luckmann
Roger S
RS
Savageau
Judith A
JA
D000328:Adult; D001294:Attitude to Health; D002908:Chronic Disease; D003153:Community Health Services; D006306:Health Surveys; D006801:Humans; D009294:Narcotics / Q000009:adverse effects / Q000627:therapeutic use; D009293:Opioid-Related Disorders / Q000517:prevention & control; D010146:Pain / Q000188:drug therapy / Q000517:prevention & control; D059408:Pain Management; D017060:Patient Satisfaction; D011320:Primary Health Care
D009294:Narcotics