Protecting Pain Patients. The Evaluation of a Chronic Pain Educational Intervention.
BACKGROUND
Advocacy and commercially funded education successfully reduced barriers to the provision of long-term opioid analgesia. The subsequent escalation of opioid prescribing for chronic noncancer pain has seen increasing harms without improved pain outcomes.


METHODS
This was a one-group pretest-posttest design study. A multidisciplinary team developed a chronic pain educational package for general practitioner trainees emphasizing limitations, risk-mitigation, and deprescribing of opioids with transition to active self-care. This educational intervention incorporated prereadings, a resource kit, and a 90-minute interactional video case-based workshop incorporated into an education day. Evaluation was via pre- and postintervention (two months) questionnaires. Differences in management of two clinical vignettes were tested using McNemar's test.


RESULTS
Of 58 eligible trainees, 47 (response rate = 81.0%) completed both questionnaires (36 of whom attended the workshop). In a primary analysis including these 47 trainees, therapeutic intentions of tapering opioid maintenance for pain (in a paper-based clinical vignette) increased from 37 (80.4%) pre-intervention to 44 (95.7%) postintervention (P = 0.039). In a sensitivity analysis including only trainees attending the workshop, 80.0% pre-intervention and 97.1% postintervention tapered opioids (P = 0.070). Anticipated initiation of any opioids for a chronic osteoarthritic knee pain clinical vignette reduced from 35 (74.5%) to 24 (51.1%; P = 0.012) in the primary analysis and from 80.0% to 41.7% in the sensitivity analysis (P = 0.001).


CONCLUSIONS
Necessary improvements in pain management and opioid harm avoidance are predicated on primary care education being of demonstrable efficacy. This brief educational intervention improved hypothetical management approaches two months subsequently. Further research measuring objective changes in physician behavior, especially opioid prescribing, is indicated.
School of Medicine and Public Health, University of Newcastle, Callaghan, New South Wales, Australia.|Drug and Alcohol Clinical Services, Hunter New England Local Health District, New South Wales, Australia.
Simon
S
Holliday
School of Medicine and Public Health, University of Newcastle, Callaghan, New South Wales, Australia.|Hunter Integrated Pain Service, New Lambton Heights, New South Wales, Australia.
Chris
C
Hayes
School of Medicine and Public Health, University of Newcastle, Callaghan, New South Wales, Australia.|Drug and Alcohol Clinical Services, Hunter New England Local Health District, New South Wales, Australia.
Adrian
A
Dunlop
General Practice Training Valley to Coast, Mayfield, New South Wales, Australia.
Simon
S
Morgan
General Practice Training Valley to Coast, Mayfield, New South Wales, Australia.
Amanda
A
Tapley
General Practice Training Valley to Coast, Mayfield, New South Wales, Australia.
Kim
K
Henderson
National Drug and Alcohol Research Centre (NDARC), University of New South Wales, Sydney, New South Wales, Australia.
Briony
B
Larance
School of Medicine and Public Health, University of Newcastle, Callaghan, New South Wales, Australia.|General Practice Training Valley to Coast, Mayfield, New South Wales, Australia.
Parker
P
Magin
D000328:Adult; D000701:Analgesics, Opioid / Q000627:therapeutic use; D059350:Chronic Pain / Q000628:therapy*; D004501:Education, Medical / Q000379:methods*; D005260:Female; D058005:General Practitioners / Q000193:education*; D006801:Humans; D008297:Male; D059408:Pain Management / Q000379:methods*; D010818:Practice Patterns, Physicians'; D011320:Primary Health Care / Q000379:methods
D000701:Analgesics, Opioid
Addiction; Education, medical graduate; Family practice; General practice; Opioids; Pain Management; Pain Training Programs