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Physician management of moderate-to-severe acute pain: Results from the Physicians Partnering Against Pain (P3) Study

Bill H. McCarberg, MD, Aarti A. Patel, PharmD, MBA, Carmela J. Benson, MS, Samir H. Mody, PharmD, MBA, Wing Chow, PharmD, MPH, Carla L. Zema, PhD, Gary J. Vorsanger, PhD, MD, Myoung S. Kim, PhD, MBA, MA

Abstract


Objective: To evaluate differences among physician specialties in the management of acute pain including prescribing practices and management of opioid-related side effects.

Design and participants: The Physicians Partnering Against Pain (P3) survey was a nationwide study of US physicians and their patients with severe to moderate acute pain (<3 months).

Main measures: Physicians were surveyed about volume of patients with moderate-to-severe acute pain in their practice, frequency of prescribing opioid analgesics, percentage of these patients returning for a follow-up visit after treatment, reasons patients discontinue treatment, frequency of recommending or prescribing treatment for opioid-related gastrointestinal (GI) side effects, and frequency of patients taking opioid analgesics that take additional treatments to manage GI side effects.

Results: The 5,982 participating physicians represented primary care physicians (PCPs; 52 percent), pain specialists (25 percent), and other specialists (23 percent). PCPs and other specialists were less likely than pain specialists to prescribe opioid analgesics to patients (25.8 percent, 29.5 percent, and 44.8 percent, respectively). The vast majority of pain specialists (78 percent) also indicated that more than three quarters of their patients returned for a follow-up visit compared with only 40 percent of PCPs and 65 percent of other specialists. When ranking the reasons why they think patients discontinue opioid analgesics, pain specialists ranked unacceptable side effects higher than PCPs and other specialists. PCPs and pain specialists were more likely than other specialists to recommend or prescribe treatments to manage opioid-related side effects, such as nausea, vomiting, and constipation (38.3 percent, 38.5 percent, and 23.1 percent, respectively).

Conclusion: The P3 Study confirms the challenge of pain management while balancing tolerability of opioid treatments from the physician perspective.


Keywords


acute pain management, GI side effects, physician prescribing behavior, PCP, pain specialists

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References


Institute of Medicine (IOM): Relieving Pain in America: A Blueprint for Transforming Prevention, Care, Education, and Research. Washington, DC: The National Academies Press, 2011.

National Pharmaceutical Council (NPC): Pain: Current Understanding of Assessment, Management and Treatments. Reston, VA: NPC, 2001.

Manchikanti L, Helm S, Fellows B, et al.: Opioid epidemic in the United States. Pain Physician. 2012; 15: ES9-ES38.

Max MB, Donovan M, Miaskowski CA, et al.: Quality improvement guidelines for the treatment of acute pain and cancer pain. JAMA. 1995; 274(23): 1874-1880.

McNeill JA, Sherwood GD, Starck PL: The hidden error of mismanaged pain: A systems approach. J Pain Symptom Manage. 2004; 28(1): 47-58.

Apfelbaum JL, Chen C, Mehta SS, et al.: Postoperative pain experience: Results from a national survey suggest postoperative pain continues to be undermanaged. Anesth Analg. 2003; 97(2): 534-540.

Todd KH, Ducharme J, Choiniere M, et al.: Pain in the emergency department: Results of the pain and emergency medicine initiative (PEMI) multicenter study. J Pain. 2007; 8(6): 460-466.

Brown JC, Klein EJ, Lewis CW, et al.: Emergency department analgesia for fracture pain. Ann Emerg Med. 2003; 42(2): 197-205.

McCarberg BH, Nicholson BD, Todd KH, et al.: The impact of pain on quality of life and the unment needs of pain management: Results from pain sufferers and physicians participating in an Internet survey. Am J Ther. 2008; 15(4): 312-320.

Brennan F, Carr DB, Cousins M: Pain management: A fundamental human right. Anesth Analg. 2007; 105(1): 205-221.

American Medical Directors Association: Pain Management in the Long-Term Care Setting: Clinical Practice Guideline. Columbia, MD: AMDA, 2009.

Hoffmann DE, Tarzian AJ: Achieving the right balance in oversight of physician opioid prescribing for pain: The role of state medical boards. J Law Med Ethics. 2003; 31(1): 21-40.

Moore RA, McQuay HJ: Prevalence of opioid adverse events in chronic non-malignant pain: Systematic review of randomized trials of oral opioids. Arthritis Res Ther. 2005; 7(5): R1046-R1051.

Kalso E, Edwards JE, Moore RA, et al.: Opioids in chronic non-cancer pain: Systematic review of efficacy and safety. Pain. 2004; 112(3): 372-380.

Panchal SJ, Muller-Schwefe P, Wurzelmann JI: Opioid-induced bowel dysfunction: Prevalence, pathophysiology and burden. Int J Clin Pract. 2007; 61(7): 1181-1187.

Moscovitz BL, Benson CJ, Patel AA, et al.: Analgesic treatment for moderate-to-severe acute pain in the United States: Patients’ perspectives in the Physicians Partnering Against Pain Survey (P3) Survey. J Opioid Manag. 2011; 7(4): 277-286.

American Association of Medical Colleges (AAMC): 2011 State Physician Workforce Data Book. Washington, DC: AAMC, 2011.




DOI: https://doi.org/10.5055/jom.2013.0182

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