title: Targeting practitioners: A review of guidelines, training, and policy in pain management.
abstract: This paper reviews the current literature on clinical guidelines, practitioner training, and government/payer policies that have come forth in response to the national rise in prescription opioid overdoses. A review of clinical opioid prescribing guidelines highlights the need for more research on safe and effective treatment options for chronic pain, improved guidance for the best management of post-operative pain, and evaluation of the implementation and impact of guideline recommendations on patient risk and outcomes. Although there is increasing attention to training in pain management in medical schools and medical residency programs, educational opportunities remain highly variable, and the need for additional clinician training in the recognition and treatment of pain as well as opioid use disorder has been recognized. Mandated use of private, federal and state educational and clinical initiatives such as Risk Evaluation and Mitigation Strategies (REMS) and Prescription Drug Monitoring Programs (PDMPs) generally increase utilization of these initiatives, but more research is needed to determine the impact of these initiatives on provider behaviors, treatment access, and patient outcomes. Finally, there is an acute need for more research on safe and effective treatments for chronic pain as well as an increased multi-level focus on improving training and access to evidence-based treatment for opioid use disorder as well as non-pharmacologic and non-interventional chronic pain treatments, so that these guideline-recommended interventions can become mainstream, accessible, first-line interventions for chronic pain and/or opioid use disorders.
authors.affiliation: Department of Psychiatry and Behavioral Sciences, College of Medicine, Medical University of South Carolina, Charleston, SC, United States. Electronic address: stephen@musc.edu.
authors.forename: Kelly S
authors.initials: KS
authors.lastname: Barth
authors.affiliation: Department of Psychiatry and Behavioral Sciences, College of Medicine, Medical University of South Carolina, Charleston, SC, United States. Electronic address: guille@musc.edu.
authors.forename: Constance
authors.initials: C
authors.lastname: Guille
authors.affiliation: Department of Psychiatry and Behavioral Sciences, College of Medicine, Medical University of South Carolina, Charleston, SC, United States. Electronic address: mccaule@musc.edu.
authors.forename: Jenna
authors.initials: J
authors.lastname: McCauley
authors.affiliation: Department of Psychiatry and Behavioral Sciences, College of Medicine, Medical University of South Carolina, Charleston, SC, United States. Electronic address: bradyk@musc.edu.
authors.forename: Kathleen T
authors.initials: KT
authors.lastname: Brady
mesh_terms: D000701:Analgesics, Opioid / Q000009:adverse effects* / Q000627:therapeutic use*; D059350:Chronic Pain / Q000188:drug therapy*; D016903:Drug Monitoring / Q000379:methods; D062787:Drug Overdose / Q000517:prevention & control; D004502:Education, Medical, Continuing; D019983:Guideline Adherence; D006291:Health Policy; D006801:Humans; D007396:Internship and Residency; D009293:Opioid-Related Disorders / Q000517:prevention & control; D059408:Pain Management / Q000379:methods*; D010149:Postoperative Pain / Q000188:drug therapy*; D055553:Prescription Drugs / Q000009:adverse effects* / Q000627:therapeutic use*; D018570:Risk Assessment; D016896:Treatment Outcome; D014481:United States
chemical_list: D000701:Analgesics, Opioid; D055553:Prescription Drugs
keywords: Guidelines; Opioids; Pain; Policy; Training