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Health Services Research & Development

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2006 HSR&D National Meeting Abstract


3027 — Challenges in Treating Patients with Chronic Non-Cancer Pain: Perceptions of Primary Care Providers

Author List:
Kerr EA (Center for Practice Management and Outcomes Research, VA Ann Arbor Healthcare System)
Davis JA (Center for Practice Management and Outcomes Research, VA Ann Arbor Healthcare System)
Silveira MJ (Center for Practice Management and Outcomes Research, VA Ann Arbor Healthcare System)
Krein SL (Center for Practice Management and Outcomes Research, VA Ann Arbor Healthcare System)

Objectives:
Over 60% of VA primary care patients report presence of chronic non-cancer pain. To effectively treat patients with chronic pain, primary care providers (PCPs) may require additional resources and training, but we know little about provider perspectives of chronic pain management. We therefore examined challenges PCPs face in treating patients with chronic non-cancer pain and whether their perceptions are associated with confidence in prescribing opioid medications.

Methods:
We conducted a written anonymous survey of a random sample of 489 VA PCPs regarding their perspectives on and treatment of chronic non-cancer pain. Six questions that addressed confidence in prescribing and managing opioid medications were used to construct an opioid confidence scale (alpha=0.90). We examined associations between tertiles of the opioid confidence scales and aspects of pain management using the chi-square statistic and multivariate logistic regression.

Results:
278 (57%) providers responded. Of these, 36% reported that they did not receive adequate training in chronic pain management principles, 40% felt that most patients with chronic pain should be treated by a pain specialist, 68% were dissatisfied with the ease of obtaining pain specialty consultations, and 27% reported treating pain conditions beyond their scope of experience. PCPs with the lowest opioid confidence were more likely than those with higher confidence to report that patients with chronic pain should be treated by a specialist (50% vs. 23%, p=0.001), that they did not receive adequate training (52% vs. 24%; p<0.001), and that they were treating pain beyond their scope of experience (46% vs. 16%, p<0.001). Associations persisted after adjusting for years of practice, provider type, and gender.

Implications:
VA PCPs face multiple challenges in managing patients with chronic non-cancer pain. A large proportion felt that chronic pain patients should be treated by specialists and a quarter reported practicing beyond their scope of experience. PCPs with lower confidence in prescribing opioid medications were more likely to report challenges in managing chronic non-cancer pain.

Impacts:
Given the large proportion of patients in VA with chronic pain, it is imperative that we further investigate how organization of care and provider training influences treatment of patients with chronic pain conditions.


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