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Preferences, experience, and attitudes in the management of chronic pain and depression: a comparison of physicians and medical students.

Hirsh AT, Hollingshead NA, Bair MJ, Matthias MS, Kroenke K. Preferences, experience, and attitudes in the management of chronic pain and depression: a comparison of physicians and medical students. The Clinical Journal of Pain. 2014 Sep 1; 30(9):766-74.

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OBJECTIVES: The current study investigated clinicians' treatment preferences for chronic pain and depression and the extent to which these preferences were related to clinicians' experience and attitudes. METHODS: Eighty-five participants (50 physicians, 35 medical students) made treatment recommendations for 8 virtual patients with chronic low back pain and depression. The 10 treatment options included pharmacological and nonpharmacological approaches. Participants also provided information about their clinical experience and completed measures assessing their attitudes toward patients with pain and depression. RESULTS: The highest recommended treatments were over-the-counter medications and topical modalities, whereas "no intervention," referral to a pain specialist, and opioid medication received the lowest ratings. Physicians gave higher ratings to physical therapy (P < 0.05) and lifestyle activities (P < 0.05) than did medical students. Students reported more negative attitudes about patients with depression (P < 0.05) than did physicians. After controlling for participants' attitudes, the treatment preferenceƗtraining level interaction was no longer significant (P > 0.05). DISCUSSION: Physicians and medical students shared a general preference for "low-risk," self-management approaches for chronic pain and depression; however, they differed in their recommendations for some specific treatments. Participants' attitudes toward patients with pain and depression were associated with their preferences and accounted for the differences in their treatment decisions. These results suggest a need for early and continuing education to reduce clinicians' negative attitudes toward and improve the management of patients with chronic pain and depression.

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