title: Physicians' comfort in caring for patients with chronic nonmalignant pain.
abstract: BACKGROUND
  More than 100 million U.S. adults experience chronic nonmalignant pain. Many physicians are uncomfortable managing such patients. We sought to determine the timing and intensity of training that primary care physicians receive in chronic pain treatment, and the effect of training on their comfort in managing patients.
  
  
  METHODS
  The 4P Study was a cross-sectional study conducted at 12 academic medical centers in the United States. More than 500 primary care physicians completed a survey regarding their attitudes toward patients with chronic nonmalignant pain and their education in chronic pain management.
  
  
  RESULTS
  We received 572 surveys out of 753 distributed. The respondents' mean age was 35 years; 64% were white, non-Hispanic and 41% were women. Eighty-eight percent were internists, and mean years spent in practice were 7.6. Fifty-seven percent of the physicians felt that they should serve as the principal doctor managing patients with chronic nonmalignant pain. Only 34% of physicians felt comfortable in managing patients with chronic pain. More intensive education after entry into practice was associated with the highest comfort level.
  
  
  CONCLUSIONS
  Most primary care physicians are not comfortable treating patients with chronic nonmalignant pain. Education increases primary care physicians' comfort in managing these patients. Increased comfort was associated with the willingness of primary care physicians to take charge of managing chronic pain. In addition, physician comfort is greatest when pain management skills are taught after residency training.
authors.affiliation: University of Texas Health Science Center at San Antonio, San Antonio, Texas 78229, USA. oroke@uthscsa.edu
authors.forename: Jane E
authors.initials: JE
authors.lastname: O'Rorke
authors.forename: Ian
authors.initials: I
authors.lastname: Chen
authors.forename: Inginia
authors.initials: I
authors.lastname: Genao
authors.forename: Mukta
authors.initials: M
authors.lastname: Panda
authors.forename: Sam
authors.initials: S
authors.lastname: Cykert
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000698:Analgesia; D002908:Chronic Disease; D004501:Education, Medical; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D059408:Pain Management; D010820:Physicians / Q000523:psychology*; D011795:Surveys and Questionnaires