title: Assessing chronic pain treatment practices and evaluating adherence to chronic pain clinical guidelines in outpatient practices in the United States.
abstract: Chronic pain is a major health concern in the United States. Several guidelines have been developed for clinicians to promote effective management and provide an analytical framework for evaluation of treatments for chronic pain. This study explores sample population demographics and the utilization of various therapeutic modalities in an adult population with common nonmalignant chronic pain (NMCP) indications in U.S. outpatient settings. A cross-sectional study using the National Ambulatory Medical Care Survey (NAMCS) data from 2000 to 2007 was used to analyze various treatment practices for the management of NMCP and evaluate the results in comparison with guidelines. The study population of 690,205,290 comprised 63% females, with 45.17% of patient visits occurring in primary care settings. Treatment with at least 1 chronic pain medication was reported in 99.7% of patients. Nonsteroidal anti-inflammatory agents were the most common treatment prescribed, with use reported in approximately 95% of the patient visits. No other pain medication drug class or nonmedication therapy was prescribed more than 26.4%. These results point to a potential underutilization of many recommended NMCP treatments including combination therapies and the need for enhanced education of chronic pain guidelines.
  
  
  CONCLUSIONS
  This study, representing over 690 million patient visits, contributes to the relative paucity of data on the use of therapeutic modalities in the management of NMCP. These results may assist clinicians and healthcare policymakers in identifying areas where practices are at odds with guidelines with the goal to improve care.
authors.affiliation: Division of Pharmacy Practice and Administration, University of Missouri-Kansas City School of Pharmacy, Kansas City, Missouri 64110, USA.
authors.forename: Rafia S
authors.initials: RS
authors.lastname: Rasu
authors.forename: Rose
authors.initials: R
authors.lastname: Sohraby
authors.forename: Lindsay
authors.initials: L
authors.lastname: Cunningham
authors.forename: Maureen E
authors.initials: ME
authors.lastname: Knell
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D002487:Centers for Disease Control and Prevention, U.S.; D059350:Chronic Pain / Q000175:diagnosis* / Q000453:epidemiology / Q000628:therapy*; D004363:Drug Utilization / Q000706:statistics & numerical data; D005260:Female; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D019538:Health Care Surveys; D006801:Humans; D008297:Male; D008875:Middle Aged; D010045:Outpatients / Q000706:statistics & numerical data*; D018710:Pain Clinics / Q000706:statistics & numerical data; D059408:Pain Management / Q000379:methods / Q000592:standards / Q000706:statistics & numerical data; D014481:United States; D055815:Young Adult