scholarly journals Understanding how primary care clinicians make sense of chronic pain

2018 ◽  
Vol 20 (4) ◽  
pp. 575-584 ◽  
Author(s):  
Laura G. Militello ◽  
Shilo Anders ◽  
Sarah M. Downs ◽  
Julie Diiulio ◽  
Elizabeth C. Danielson ◽  
...  
Keyword(s):  
Primary Care ◽  
Chronic Pain ◽  
Primary Care Clinicians

How opioid prescribing policies influence primary care clinicians’ treatment decisions and conversations with patients with chronic pain

2021 ◽  
Vol 17 (6) ◽  
pp. 499-509
Author(s):  
Elizabeth C. Danielson, PhD ◽  
Christopher A. Harle, PhD ◽  
Sarah M. Downs, MPH ◽  
Laura Militello, MA ◽  
Olena Mazurenko, MD, PhD
Keyword(s):  
Primary Care ◽  
Chronic Pain ◽  
Treatment Decisions ◽  
Healthcare Organizations ◽  
Chronic Noncancer Pain ◽  
Opioid Prescribing ◽  
Prevention Guideline ◽  
Multistep Process ◽  
Primary Care Clinicians ◽  
Noncancer Pain

Objective: The 2016 Centers for Disease Control and Prevention guideline for prescribing opioids for chronic pain aimed to assist primary care clinicians in safely and effectively prescribing opioids for chronic noncancer pain. Individual states, payers, and health systems issued similar policies imposing various regulations around opioid prescribing for patients with chronic pain. Experts argued that healthcare organizations and clinicians may be misapplying the federal guideline and subsequent opioid prescribing policies, leading to an inadequate pain management. The objective of this study was to understand how primary care clinicians involve opioid prescribing policies in their treatment decisions and in their conversations with patients with chronic pain.Design: We conducted a secondary qualitative analysis of data from 64 unique primary care visits and 87 post-visit interviews across 20 clinicians from three healthcare systems in the Midwestern United States. Using a multistep process and thematic analysis, we systematically analyzed data excerpts addressing opioid prescribing policies.Results: Opioid prescribing policies influenced clinicians’ treatment decisions to not initiate opioids, prescribe fewer opioids overall (theme #1), and begin tapering and discontinuation of opioids (theme #2) for most patients with chronic pain. Clinical precautions, described in the opioid prescribing policies to monitor use, were directly invoked during visits for patients with chronic pain (theme #3).Conclusions: Opioid prescribing policies have multidimensional influence on clinician treatment decisions for patients with chronic pain. Our findings may inform future studies to explore mechanisms for aligning pressures around opioid prescribing, stemming from various opioid prescribing policies, with the need to deliver individualized pain care.

scholarly journals (357) Impact of the Harborview Integrated Pain Care Program on primary care clinicians’ perceived confidence to care for patients with complex chronic pain

2017 ◽  
Vol 18 (4) ◽  
pp. S64
Author(s):  
I. Lesnik ◽  
S. Jackson ◽  
J. Huntington ◽  
J. Ballantyne ◽  
A. Nowlin ◽  
...  
Keyword(s):  
Primary Care ◽  
Chronic Pain ◽  
Care Program ◽  
Primary Care Clinicians ◽  
Pain Care

Psychotherapeutic interventions for chronic pain: Evidence, rationale, and advantages

2018 ◽  
Vol 54 (2) ◽  
pp. 140-149 ◽  
Author(s):  
Muhammad Hassan Majeed ◽  
Ali Ahsan Ali ◽  
Donna M Sudak
Keyword(s):  
Primary Care ◽  
Chronic Pain ◽  
Behavioral Therapy ◽  
Health Resources ◽  
Opioid Use ◽  
Medical Problems ◽  
Pharmacological Management ◽  
Acceptance And Commitment ◽  
Primary Care Clinicians ◽  
The Individual

Background Long-term use of opioids to treat chronic pain incurs serious risks for the individual—including misuse, abuse, addiction, overdose and death—as well as creating economic, social, and cultural impacts on society as a whole. Chronic pain and substance use disorders are often co-morbid with other medical problems and at the present time, primary care clinicians serve most of this population. Primary care clinicians would benefit from having alternatives to opioids to employ in treating such patients. Method We electronically searched different medical databases for studies evaluating the effect of nonpharmacological treatments for chronic pain. We describe alternative approaches for the treatment of chronic pain and cite studies that provide substantial evidence in favor of the use of these treatments. Results Cognitive behavioral therapy, acceptance and commitment therapy, and mindfulness-based programs have well-documented effectiveness for the treatment of chronic nonmalignant pain. Integration of such behavioral health therapies into primary care settings may optimize health resources and improve treatment outcomes. Conclusion Evidence-based psychotherapy for chronic pain has established efficacy and safety and improves quality of life and physical and emotional functioning. Such interventions may be used as an alternative or adjunct to pharmacological management. Chronic opioid use should be reserved for individuals undergoing active cancer treatment, palliative care, or end-of-life care.

scholarly journals Primary Care Clinicians’ Beliefs and Strategies for Managing Chronic Pain in an Era of a National Opioid Epidemic

2020 ◽  
Vol 35 (12) ◽  
pp. 3542-3548
Author(s):  
Laura G. Militello ◽  
Robert W. Hurley ◽  
Robert L. Cook ◽  
Elizabeth C. Danielson ◽  
Julie Diiulio ◽  
...  
Keyword(s):  
Primary Care ◽  
Chronic Pain ◽  
Opioid Epidemic ◽  
Primary Care Clinicians

scholarly journals Veterans Affairs Primary Care Clinicians' Attitudes toward Chronic Pain and Correlates of Opioid Prescribing Rates

Pain Medicine ◽  
2008 ◽  
Vol 9 (5) ◽  
pp. 564-571 ◽  
Author(s):  
Steven K. Dobscha ◽  
Kathryn Corson ◽  
Jennifer A. Flores ◽  
Erin C. Tansill ◽  
Martha S. Gerrity
Keyword(s):  
Primary Care ◽  
Chronic Pain ◽  
Veterans Affairs ◽  
Opioid Prescribing ◽  
Primary Care Clinicians

PREP — The Preoperative Risk Education Package: an online educational resource for primary care clinicians to encourage community based prehabilitation prior to major surgery

2018 ◽  
Vol 68 (suppl 1) ◽  
pp. bjgp18X697277
Author(s):  
James Durrand ◽  
F McHardy ◽  
E Land ◽  
Z Llewellyn ◽  
C Norman ◽  
...  
Keyword(s):  
Risk Factors ◽  
Primary Care ◽  
Perioperative Risk ◽  
Perioperative Outcomes ◽  
Major Surgery ◽  
Educational Resource ◽  
Major Step ◽  
Early Evaluation ◽  
Risk Education ◽  
Primary Care Clinicians

BackgroundPrehabilitation prior to major surgery mandates cross-sector working. Utilising the preoperative window from referral requires clinician engagement. Awareness of perioperative risk factors is crucial. A national survey uncovered gaps in knowledge and understanding.AimCreate an open-access, online educational resource for primary care clinicians.MethodOur multidisciplinary team developed a focused CPD resource targeting lifestyle factors and chronic health conditions influencing perioperative risk (www.prepwell.co.uk).ResultsPREP highlights seven risk factors influencing perioperative risk: Smoking, alcohol, inactivity, anaemia, cognitive impairment, frailty and low BMI. A case study frames each factor alongside perioperative impact and prehabilitation strategies.ConclusionPREP is the first educational resource of its type. Early evaluation through local clinicians, the RCGP and RCOA has resulted in very positive feedback. We are working with Royal College representatives to gain formal endorsement and facilitate wider scale rollout, a major step towards raised clinician awareness and enhanced collaboration for improved perioperative outcomes.

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