Low Confidence, Comfort in Opioid Prescribing Linked to Greater Pain Treatment Dissatisfaction among Family Physicians

In a cohort of family medicine physicians, researchers found a strong inverse relationship between confidence and comfort toward opioid prescribing and concern about negative consequences.

The increasing prevalence of chronic non-cancer pain combined with the shortage of pain management specialists have put many family medicine physicians in charge of handling chronic pain complaints and prescribing opioids accordingly, despite significant obstacles that include inadequate medical training on pain management and little knowledge on the drugs’ misuse potential.

In light of those challenges, a team of researchers from Philadelphia, PA, and Columbus, OH, has surveyed a diverse sample of US family medicine practitioners to examine their current practices, attitudes, experiences, and levels of concern toward prescribing opioids to treat their chronic pain patients, which no previous studies had ever bothered to explore.

For their “Family Medicine Physicians’ Confidence, Comfort, Experiences, and Beliefs towards Opioid Analgesic Prescribing for Patients with Chronic Nonmalignant Pain” poster presented at PAINWeek 2013, Lorraine Wallace, PhD, FAAHB, an associate professor of family medicine at the Ohio State University College of Medicine; Ian M. Bennett, an associate professor of family medicine and community health at the Hospital of the University of Pennsylvania; and their colleagues reviewed answers from 491 family physicians — more than half of whom were male — on chronic pain management questions addressing current opioid prescribing practices, experiences and beliefs toward prescribing opioids, concerns about negative opioid-related outcomes, and confidence and comfort when prescribing opioids.

According to the study authors, those survey responses uncovered that although more than 95 percent of the family medicine physicians reported prescribing opioids in their current practice —and the majority those physicians felt “somewhat” or “strongly” confident and comfortable in their opioid prescribing — more than 80 percent “did not find it satisfying to prescribe opioids to patients with chronic pain,” and about 65 percent were “concerned about negative patient outcomes and noncompliance.”

The 76.2 percent of surveyed family physicians who indicated that they were comfortable in their opioid prescribing skills were “more likely to report satisfaction in prescribing opioids to chronic pain patients, that patents function better with opioids, and that patients experience substantial pain relief with opioids,” while the 88.4 percent of responders who said they were confident in their opioid prescribing skills were “more likely to identify pain management as high priority, found greater satisfaction in prescribing opioids, and were less likely to be concerned about getting into trouble with regulatory authorities.”

Since the survey responses demonstrated “a strong inverse relationship between confidence regarding opioid prescription and concern about negative consequences (such as the) likelihood of patient overdose” and showed that “comfort level was tied to increased satisfaction with the overall process of opioid prescription,” the researchers said those associations should “encourage further investigation into the underlying causes of this dissatisfaction,” as the study findings as a whole “underscore the need for continued education and training in chronic pain management — including sensible opioid prescribing — throughout family medicine training.”