Tuesday, November 20, 2012

MD Trainees Wary of Ordering Opioids for Chronic Pain

by Dana Hawkins-Simons

Many physicians-in-training are reluctant to prescribe opioid analgesics for long-term pain management, a recent study has found.

“Most surveys are done with family medical practitioners,” said Ike I. Eriator, MD, MPH, professor of anesthesiology and pain management at the University of Mississippi Medical Center in Jackson, who led the study. “But if we look at how physicians-in-training think, it gives us a clue as to what a practitioner of the future might do.” The study results were presented at the 2012 annual meeting of the American Pain Society (abstract 242).

The researchers queried 93 trainees from the areas of emergency medicine, general surgery, psychiatry, internal medicine, family medicine and neurology, as well as 16 medical students about their pain treatment practices. Nearly half (45%) said they treated chronic pain on a regular basis. Twenty-one percent of respondents stated they felt comfortable treating chronic pain, whereas 34% felt it depended on the situation. However, 81% reported feeling uncomfortable prescribing long-term narcotics for chronic pain patients.

There was no significant relationship between treating chronic pain on a regular basis and comfort with prescribing long-term narcotics among the physicians. Women were more likely than their male colleagues to feel uncomfortable prescribing long-term narcotics. Trainees who felt comfortable managing chronic pain also were significantly more likely to feel comfortable prescribing long-term narcotics.

The most common concern with prescribing long-term narcotics was the risk for chemical dependency or addiction (37%), closely followed by escalating opioid doses (35%); 3.4% of respondents cited legal considerations.

“A few decades ago, the legal environment was the main impediment to prescribing opioids,” Dr. Eriator said. “Maybe that has changed because law enforcement has relaxed its prosecution over recent years of medical practitioners who prescribe opioids.” 

Dr. Eriator said the results of the study could be used to help focus pain management training in the areas where residents are most deficient.

“At an anesthesiology meeting several years ago, we presented data that showed residents’ knowledge of acute pain treatment varied across specialties,” he said. “For instance, orthopedic residents were more likely to attribute increasing requests for medication to the development of tolerance, while family medicine residents would attribute it to addiction. We could focus their education on the areas where they need more knowledge.”

Dr. Eriator said he would like to use the same questionnaire to survey medical students on their comfort level and concerns regarding pain management and how it changes when they become physicians.

A healthy respect for how complicated it is to treat pain is a good thing, said Steven Passik, PhD, professor of psychiatry and anesthesiology at Vanderbilt University School of Medicine in Nashville.

“Medical education on pain and addiction is sorely lacking, and training about the interface between pain and addiction is virtually nonexistent,” he said. “We should teach the physicians-in-training to use their discomfort to seek training throughout their career.”

Anesthesiology News 

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