Chronic Conditions

Family medicine physicians suggest ways to improve management of chronic pain in primary care patients

Primary care doctors are typically the ones who see patients suffering from chronic non-malignant pain. Concerns about patient opioid abuse and the threat of criminal charges against physicians for inappropriate opioid prescribing make pain management difficult for these doctors. In addition, many of them don't feel adequately trained to treat chronic non-malignant pain, note Linda Garufi Clark, M.D., and Carole C. Upshur, Ed.D., of the University of Massachusetts Medical School. They elicited comments from 14 family medicine physicians from 6 practice sites via group discussions and written feedback.

The physicians suggested several changes they thought would benefit them and patients coping with non-malignant chronic pain. They cited a need for a physician practice guideline tool kit. Some suggested that the kit include a screener for potential addiction problems; model opioid contracts; analgesic flow sheets; treatment guidelines; and contact information for pain clinics, behavioral health services, and other local resources.

Many physicians also called for redesign of the opioid refill process, which currently requires patients to pick up a new refill prescription from their doctor each month. The system caused much anxiety and conflict for both patients and physicians, who often felt chased and hounded by their patients. Physicians felt that patients suffering with pain would most benefit from improved access to medication refills, reduced barriers to communication with the primary care doctor, and better access to affordable and culturally sensitive treatments other than medication (for example, physical therapy, supervised exercise, massage, and chiropractors). Physicians believed they would benefit from the support of a care manager to manage prescription refills and patient communication.

The study was supported by the Agency for Healthcare Research and Quality (HS13455).

See "Family medicine physicians' views of how to improve chronic pain management," by Drs. Clark and Upshur, in the September 2007 Journal of the American Board of Family Medicine 20(5), pp. 479-482.

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