More on Current Issues in Pain Management for the Primary Care Practitioner Acute Pain

Background: To date, Atrius Health has not assessed how often patients request additional pain medication after receiving an initial opioid for acute pain management. This assessment was requested to help justify prescribing patterns for opioids in the primary care setting. Objective: To assess the amount of requests for additional opioid prescriptions in patients who received a short-acting opioid for acute pain management. Methods: This was a retrospective chart review of a multicenter large ambulatory care organization in the Greater Boston Area. Atrius Health patients who received an initial prescription for a short-acting oral opioid indicated for acute pain management between May 1, 2016, and October 1, 2016, were included in the study. Results: The overall percentage of patients requesting additional medication for acute pain management was 13% (46/350). Of the 46 patients who requested additional medication, 15 patients received a second opioid prescription (33%, 15/46). For those patients who requested additional pain medication, there were no trends between the day supply that was prescribed and a patient receiving a second opioid prescription from a health care provider. Patients who received a 4- to 5-day supply of opioids were not more likely to call back requesting additional pain medication than patients who received a 1- to 3-day supply of opioids (odd ratio = 0.41; 95% confidence interval = 0.17-1.00). Conclusion: At Atrius Health, roughly 13% of patients are requesting additional pain medications after being prescribed a short-acting opioid for acute pain management. Other primary care and urgent care health systems may consider reducing the day supply of opioids prescribed for acute pain management.

Download Full-text

Acute pain management among patients with opioid maintenance therapy: specificities and difficulties identified in primary care: a qualitative study

BMJ Open ◽

10.1136/bmjopen-2020-044433 ◽

2021 ◽

Vol 11 (1) ◽

pp. e044433

Author(s):

Morgane Guillou Landreat ◽

Melia Baillot ◽

Delphine Le Goff ◽

Jean Yves Le Reste

Keyword(s):

Primary Care ◽

Pain Management ◽

Qualitative Study ◽

Medical Care ◽

Thematic Analysis ◽

Acute Pain ◽

Sampling Strategy ◽

Snowball Sampling ◽

Opioid Use ◽

Acute Pain Management

ObjectivesIn the last 30 years, opioid maintenance treatment prescription (OMT) has changed patients’ and also changed physicians’ practices. General practitioners (GPs) have to deal with patients on OMT who are in acute pain. The objective of this qualitative study was to explore medical care challenges and solutions identified by GPs in the management of acute pain among patients receiving OMT.Design and settingQualitative study with semistructured interviews were used as a data collection technique with a sampling strategy using a snowball sampling method to obtain a purposive sample of practicing GPs. Analysis was undertaken using a thematic analysis method.ParticipantsTwelve GPs, working in France (Brittany) who prescribe OMT were interviewed.ResultsThe thematic analysis resulted in two main themes relating to specificities and difficulties identified: (1) Medical care and training challenges identified by GPs treating patients on OMT with acute pain, with four subthemes : management of these situations not concerning primary care, lack of training prompts GPs to rely on peer and specialist support, lack of guidelines and conflicting recommendations between clinicians in different settings (2) linked to the patient–GP relationship, with six subthemes: Implementing an individualised centred approach, acute pain management during OMT relies on a relationship based on trust, GPs found difficulties in evaluating and treating pain, difficulties in care adherence, fear of patients destabilisation, fear of misuse and diversion.ConclusionThe complexity of acute pain and OMT entails significant challenges for clinicians and patients. In primary care, it is hard to achieve a balance between pain relief and opioid use disorder treatment, in a global patient-centred approach. Fear of misuse or diversion was not a important factor, except for patients not known to the practitioners, but GPs were concerned with the risks of patient destabilisation in situations of acute pain.

Download Full-text