title: Prescription patterns of pain medicine physicians.
abstract: OBJECTIVE
  Our study surveyed physician members of 3 American pain societies to determine prescription patterns and whether these practices reflect current expert opinion.
  
  
  METHODS
  We sent 3 mailings to 2938 physicians from January 2010 to January 2011. The questionnaire contained 49 questions on topics related to opioids, antidepressants, anticonvulsants, and preferences for the different pain syndromes.
  
  
  RESULTS
  A total of 474 physicians responded, representing a 16% return. Seventy-two percent ask patients to sign an opioid agreement, 59% order random urine drug testing, 13% wait until the dose of methadone is between 100 and 150 mg before converting the drug to another opioid, and 85% do not think there is a maximum dose of opioids with respect to driving. Most responders prescribe codeine to Caucasians and Asians. While 42% stated that the maximum daily dose of acetaminophen is 3000 mg, 75% would decrease the dose in patients who are moderate or heavy drinkers. Fifty-four percent do not order an ECG at all when prescribing tricyclic antidepressants.
  
  
  CONCLUSIONS
  The responses pertaining to opioid agreements, urine drug testing, acetaminophen, and treatment for neuropathic pain are reassuring in that they prevent misuse and abuse of opioids, prevent acetaminophen-induced hepatotoxicity, and reflect evidence-based treatments. However, we identified gaps in knowledge, including the prescription of codeine in certain populations and the use of electrocardiogram in patients on antidepressants. Further education of physicians who treat chronic pain pharmacologically is warranted.
authors.affiliation: Department of Anesthesiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, U.S.A. h-benzon@northwestern.edu
authors.forename: Honorio T
authors.initials: HT
authors.lastname: Benzon
authors.forename: Mark C
authors.initials: MC
authors.lastname: Kendall
authors.forename: Jeffrey A
authors.initials: JA
authors.lastname: Katz
authors.forename: Hubert A
authors.initials: HA
authors.lastname: Benzon
authors.forename: Khalid
authors.initials: K
authors.lastname: Malik
authors.forename: Paul
authors.initials: P
authors.lastname: Cox
authors.forename: Kathryn
authors.initials: K
authors.lastname: Dean
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Avram
mesh_terms: D000082:Acetaminophen / Q000627:therapeutic use; D000700:Analgesics / Q000627:therapeutic use*; D000701:Analgesics, Opioid / Q000627:therapeutic use; D011307:Drug Prescriptions; D006801:Humans; D008691:Methadone / Q000627:therapeutic use; D009293:Opioid-Related Disorders / Q000175:diagnosis / Q000517:prevention & control; D010146:Pain / Q000175:diagnosis / Q000188:drug therapy*; D010820:Physicians / Q000639:trends*; D011364:Professional Practice / Q000639:trends*; D011795:Surveys and Questionnaires
chemical_list: D000700:Analgesics; D000701:Analgesics, Opioid; D000082:Acetaminophen; D008691:Methadone