Professional experience guides opioid prescribing for chronic joint pain in primary care.
BACKGROUND
Chronic joint pain is common and is a leading cause of disability. Most chronic joint pain is managed in primary care. Opioid pain medication is one option for pain management, but research suggests that its use by general practitioners (GPs) may be suboptimal. There is a widespread perception that doctors' concerns about misuse and addiction limit use of opioids.


OBJECTIVE
To explore GPs' opinions about opioids and decision-making processes when prescribing 'strong' opioids for chronic joint pain.


METHODS
Qualitative semi-structured interviews were conducted with 27 GPs. Using thematic analysis methods, the data were coded and grouped into themes.


RESULTS
GPs described a variety of prescribing habits for chronic joint pain. Opioids engendered strong opinions. GPs said that decisions about prescribing were based on careful assessment of patients' needs and their personal views about the management of adverse effects. Although addiction and misuse were discussed, there was limited concern about these issues. The overarching influence on prescribing decisions was GPs' previous experience, including previous outcomes and exposure to palliative care settings.


CONCLUSIONS
GPs' prescribing decisions are primarily influenced by previous professional experience of opioids. Much existing literature stresses that opioids are not prescribed due to concerns about addiction or misuse, but our study indicates otherwise. Augmenting GPs' exposure to and experience of opioids may be key to providing better pain management for patients.
School of Clinical Sciences, University of Bristol, Southmead Hospital, Bristol, UK. r.gooberman-hill@bristol.ac.uk
Rachael
R
Gooberman-Hill
Claire
C
Heathcote
Colette M
CM
Reid
Jeremy
J
Horwood
Andrew D
AD
Beswick
Susan
S
Williams
Matthew J
MJ
Ridd
D000701:Analgesics, Opioid / Q000008:administration & dosage*; D018771:Arthralgia / Q000188:drug therapy*; D001291:Attitude of Health Personnel; D002908:Chronic Disease; D003657:Decision Making; D005260:Female; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D010818:Practice Patterns, Physicians'; D011320:Primary Health Care; D036301:Qualitative Research; D006113:United Kingdom
D000701:Analgesics, Opioid