title: Obstetrical Providers' Management of Chronic Pain in Pregnancy: A Vignette Study.
abstract: Describe obstetrical providers' management of a hypothetical case on chronic pain in pregnancy and determine whether practices differ based on patient race.
  
  
  
  This was a self-administered survey at a clinical conference.
  
  
  
  Seventy-six obstetrician-gynecologists and one nurse practitioner were surveyed.
  
  
  
  A case-vignette described a pregnant patient presenting with worsening chronic lower back pain, requesting an opioid refill and increased dosage. We varied patient race (black/white) across two randomly assigned identical vignettes. Providers indicated their likelihood of prescribing opioids, drug testing, and referring on a 0 (definitely would not) to 10 (definitely would) scale; rated their suspicions/concerns about the patient on a 0-10 VAS scale; and ranked those concerns in order of importance. We calculated correlation coefficients, stratifying analyses by patient race.
  
  
  
  Providers were not inclined to refill the opioid prescription (median = 3.0) or increase the dose (median = 1.0). They were more likely to conduct urine drug tests on white than black patients ( P = 0.008) and more likely to suspect that white patients would divert the medication ( P =0.021). For white patients, providers' highest-ranked concern was the patient's risk of abuse/addiction, whereas, for black patients, it was harm to the fetus. Suspicion about symptom exaggeration was more closely related to decisions about refilling the opioid prescriptions and increasing the dose for black patients (r = -0.357, -0.439, respectively), whereas these decisions were more closely correlated with concerns about overdose for white patients (r = -0.406, -0.494, respectively).
  
  
  
  Provider suspicion and concerns may differ by patient race, which may relate to differences in pain treatment and testing. Further study is warranted to better understand how chronic pain is managed in pregnancy.
authors.affiliation: Department of Obstetrics and Gynecology, Indiana University School of Medicine, Indianapolis, Indiana, USA.
authors.forename: Brownsyne
authors.initials: B
authors.lastname: Tucker Edmonds
authors.affiliation: Department of Obstetrics and Gynecology, Indiana University School of Medicine, Indianapolis, Indiana, USA.
authors.forename: Fatima
authors.initials: F
authors.lastname: McKenzie
authors.affiliation: Department of Obstetrics and Gynecology, Indiana University School of Medicine, Indianapolis, Indiana, USA.
authors.forename: MacKenzie B
authors.initials: MB
authors.lastname: Austgen
authors.affiliation: Department of Psychology, Indiana University-Purdue University Indianapolis, Indianapolis, Indiana, USA.
authors.forename: Leslie
authors.initials: L
authors.lastname: Ashburn-Nardo
authors.affiliation: Center for Health Information and Communication, Roudebush Veterans Affairs Medical Center, Indianapolis, Indiana, USA.|Regenstrief Institute, Indianapolis, Indiana, USA.
authors.forename: Marianne S
authors.initials: MS
authors.lastname: Matthias
authors.affiliation: Department of Psychology, Indiana University-Purdue University Indianapolis, Indianapolis, Indiana, USA.
authors.forename: Adam T
authors.initials: AT
authors.lastname: Hirsh
mesh_terms: D000328:Adult; D000368:Aged; D000701:Analgesics, Opioid / Q000627:therapeutic use; D001291:Attitude of Health Personnel / Q000208:ethnology*; D059350:Chronic Pain / Q000188:drug therapy* / Q000453:epidemiology*; D011307:Drug Prescriptions / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D008875:Middle Aged; D009774:Obstetrics / Q000706:statistics & numerical data; D059408:Pain Management / Q000706:statistics & numerical data*; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011247:Pregnancy; D011248:Pregnancy Complications / Q000188:drug therapy* / Q000453:epidemiology* / Q000208:ethnology; D044469:Racial Groups / Q000208:ethnology / Q000706:statistics & numerical data; D063505:Racism / Q000208:ethnology / Q000706:statistics & numerical data; D014481:United States / Q000208:ethnology; D044465:White People / Q000208:ethnology / Q000706:statistics & numerical data
chemical_list: D000701:Analgesics, Opioid
keywords: Chronic Pain; Opioid-Related Disorders; Pain Management; Pregnancy; Provider Practice Patterns; Provider Prescribing Patterns