Pain management by primary care physicians, pain physicians, chiropractors, and acupuncturists: a national survey.
OBJECTIVE
Chronic pain is a serious public health problem and is treated by diverse health care providers. In order to enhance policies and programs to improve pain care, we collected information about the distribution of pain patients among four major groups of pain management providers: primary care physicians (PCPs), pain physicians, chiropractors, and acupuncturists, and the variation in the attitudes and practices of these providers with respect to some common strategies used for pain.


METHODS
National mail survey of PCPs, pain physicians, chiropractors, and acupuncturists (ntotal = 3,000).


RESULTS
Eight hundred seventeen responses were usable (response rate, 29%). Analyses weighted to obtain nationally representative data showed that PCPs treat approximately 52% of chronic pain patients, pain physicians treat 2%, chiropractors treat 40%, and acupuncturists treat 7%. Of the chronic pain patients seen for evaluation, the percentages subsequently treated on an ongoing basis range from 51% (PCPs) to 63% (pain physicians). Pain physicians prescribe long-acting opioids such as methadone, antidepressants or anti-convulsants, and other nontraditional analgesics approximately 50-100% more often than PCPs. Twenty-nine percent of PCPs and 16% of pain physicians reported prescribing opioids less often than they deem appropriate because of regulatory oversight concerns. Of the four groups, PCPs are least likely to feel confident in their ability to manage musculoskeletal pain and neuropathic pain, and are least likely to favor mandatory pain education for all PCPs.


CONCLUSIONS
There is substantial variation in attitudes and practices of the various disciplines that treat chronic pain. This information may be useful in interpreting differences in patient access to pain care, planning studies to clarify patient outcomes in relation to different providers and treatment strategies, and designing a system that matches chronic pain patients to appropriate practitioners and treatments.
Breuer
Brenda
B
Department of Pain Medicine and Palliative Care, Beth Israel Medical Center, New York, NY 10003, USA. bbreuer@chpnet.org
Cruciani
Ricardo
R
Portenoy
Russell K
RK
D015667:Acupuncture Analgesia / Q000706:statistics & numerical data*; D000700:Analgesics / Q000627:therapeutic use; D000701:Analgesics, Opioid / Q000627:therapeutic use; D001291:Attitude of Health Personnel; D019538:Health Care Surveys; D006801:Humans; D026882:Manipulation, Chiropractic / Q000706:statistics & numerical data*; D015999:Multivariate Analysis; D010146:Pain / Q000188:drug therapy; D059408:Pain Management; D010821:Physicians, Family / Q000706:statistics & numerical data*; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data; D014481:United States
D000700:Analgesics; D000701:Analgesics, Opioid