title: Is It Painful to Manage Chronic Pain? A Cross-Sectional Study of Physicians In-Training in a University Program.
abstract: BACKGROUND
  Prescribing opioids for chronic non-cancer pain (CNCP) is a challenge due to associated risks from abuse, addiction and adverse effects. We surveyed resident physicians on their knowledge, attitude and practices in opioid prescription practices in the ambulatory setting and conducted an educational module to address their knowledge gaps.
  
  
  METHODS
  A phase 1 survey assessed knowledge, attitudes and practices of residents in the out-patient management of CNCP with opioids. Demographics, numbers of patients seen, those with concerns for risky behaviors, adverse effects and the reasons for concern were also recorded. In Phase 2, an educational module in the form of didactics and case based discussions addressed the perceived deficiencies noted from results of phase 1 survey. Pre and post module surveys assessed the effectiveness of the educational module.
  
  
  RESULTS
  In the phase 1 study (45/49, 92% response rate, M:F = 30:15) 33.3% (15/45) were in Post-Graduate Year (PGY) 1, 35.6% (16/45) PGY2s and 31.1% (14/45) PGY3s; 80% (36/45) saw more than one patient with CNCP in the previous 3 months; 62.2% (28/45) had at least one patient with concerns for misuse and addiction; 77.8% (35/45) and 86.7% (39/45) reported a lack of training and consistent documentation respectively, and 82.2% (37/45) were uncomfortable to refill for other provider's patients. All (100%, 45/45) consulted the clinical pharmacist; 86.7% (39/45) believed that either focused education would be beneficial. In the phase 2 study (44/49, 89.7% response rate, M: F = 29: 15), the pre- and post-module responses showed that > 90% of the residents perceived improvement in knowledge and confidence in management of CNCP with opioids after the educational module.
  
  
  CONCLUSIONS
  Internal medicine residents perceived deficits in their ability to manage CNCP. Following a focused educational training, residents' knowledge and confidence in prescription of opioids improved, demonstrating the need to include management of CNCP with opioids into their curriculum.
authors.forename: Hariharan
authors.initials: H
authors.lastname: Regunath
authors.forename: Kelly
authors.initials: K
authors.lastname: Cochran
authors.forename: Kasey
authors.initials: K
authors.lastname: Cornell
authors.forename: James
authors.initials: J
authors.lastname: Shortridge
authors.forename: Daniel
authors.initials: D
authors.lastname: Kim
authors.forename: Syed
authors.initials: S
authors.lastname: Akbar
authors.forename: Barbara
authors.initials: B
authors.lastname: Boshard
authors.forename: Rebecca
authors.initials: R
authors.lastname: Chitima-Matsiga
authors.forename: Jyotsna
authors.initials: J
authors.lastname: Reddy
authors.forename: Steven
authors.initials: S
authors.lastname: Keithahn
authors.forename: James P
authors.initials: JP
authors.lastname: Koller
mesh_terms: D000328:Adult; D000701:Analgesics, Opioid / Q000627:therapeutic use*; D001291:Attitude of Health Personnel; D059350:Chronic Pain / Q000188:drug therapy*; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D007396:Internship and Residency; D008297:Male; D059408:Pain Management; D010818:Practice Patterns, Physicians'
chemical_list: D000701:Analgesics, Opioid