Background & Aims

After a progressive phase of increased use of opiates for PNMP in the 1990/2000s driven by fears of undertreatment of pain 1, 2, 3, subsequent long-term data has not shown significant impact in terms of pain reduction or functional improvement4. Sustained high dosage opiate consumption for PNMP reportedly does not reliably decrease pain severity nor improve the overall health and function5 of those suffering PNMP but can create problems of hyperalgesia6 and endocrine dysfunction7. There is now a growing body of evidence that opiates for PNMP are not routinely indicated and in some instances may actually contribute to disease burden8.
Aims: To survey current knowledge, attitudes and beliefs (KABs) of primary care prescribers, in relation to reported prescribing of opiates for PNMP; exploring drivers for reported prescribing and any gaps in knowledge in relation to prolonged or high dose prescribing for pain populations (understanding risk & up to date guidance).

Methods

The research team consisted of Pain specialists (doctor, psychologists, physiotherapist); primary care physicians & were supported by a community pharmacist. Prior surveys of attitudes and beliefs as they relate to opioid prescribing were evaluated9,10,11 and via expert consensus questions were extracted to produce a survey which would capture demographics, attitudes & knowledge about risk & efficacy of prescribing opiates for PNCP, as well as capturing self-report of specific post-graduate pain training. All practising primary care physicians on the Island (101) were invited to take part in the survey over a one year period. Results of the survey were anonymised and analysed using SPSS. Questionnaires were analysed using Exploratory Factor analysis to identify linked items and concepts.

Results

74 responses; average 20.3 years of practice (SD10.8). 92% reported prescribing opioids, average of 7.15 prescriptions in previous month (SD6.9). Bivariate analysis indicated that the more clinical hours worked a week, the less GPs look forward to treating pain patients, the less they consider addiction to be a serious impediment to long-term opioid use, and the more they believe that relief without improvement of function is sufficient justification for opiate use (r(77)=.31, p=.006). Number of reported opioid prescriptions positively correlated with medical school pain training hours (r(38)=.34, p=.035) and GP pain training hours (r(50)=.28, p=.045), suggesting that the more hours training in pain at undergraduate and GP training, the more opioid prescriptions are made. However, hours of postgrad training correlated negatively with beliefs on the efficacy and cost-effectiveness of opioids (r( 44)=.35, p=.019).

Conclusions

73% of total registered GPs completed the survey. Well above the average rate expected for healthcare provider surveys12, giving a good overview of the entire community primary care population. Nine out of ten reported prescribing opiates for PNMP, highlighting the relevance of understanding knowledge, attitudes and beliefs in this cohort of healthcare providers. Working long hours appeared to negatively influence GPs attitudes towards treating PNMP patients, with associated less concern for addiction or expectation that functional improvement should be aligned with reported pain reduction. Higher estimates of pain education at undergraduate & GP training were associated with higher reported opiate prescribing, which may relate to an increased focus within these curricula on acute pain presentations. However, those reporting higher levels of post-graduate Pain training were less likely to believe opiate medication was effective or cost effective for PNMP treatment.

References

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2.Zenz M, Willweber-Strumpf A. Opiophobia and cancer pain in Europe. Lancet. 1993;341(8852):1075–1076.
3.Stein C. Opioid treatment of chronic nonmalignant pain. Anesth Analg. 1997;84(4):912–914.
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5.AMDG Interagency Guideline on Opioid Dosing for Chronic non-cancer pain, 2010. Washington State, USA
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8.Rosenblatt RA, Catlin M. Opioids for chronic pain: first do no harm. Ann Fam Med. 2012 Jul-Aug;10(4):300-1. doi: 10.1370/afm.1421. PMID: 22778116; PMCID: PMC3392287.
9.Bhamb B, Brown D, Hariharan J, Anderson J, Balousek S, Fleming MF. Survey of select practice behaviors by primary care physicians on the use of opioids for chronic pain. Curr Med Res Opin. 2006;22:1859–1865
10.Wolfert MZ, Gilson AM, Dahl JL, Cleary JF. Opioid analgesics for pain control: wisconsin physicians’ knowledge, beliefs, attitudes, and prescribing practices. Pain Med. 2010;11:425–434
11.Turk DC, Brody MC, Okifuji EA. Physicians’ attitudes and practices regarding the long-term prescribing of opioids for non-cancer pain. Pain. 1994;59:201–208
12.Meyer VM, Benjamens S, Moumni ME, Lange JFM, Pol RA. Global Overview of Response Rates in Patient and Health Care Professional Surveys in Surgery: A Systematic Review. Ann Surg. 2022 Jan 1;275(1):e75-e81. doi: 10.1097/SLA.0000000000004078. PMID: 32649458; PMCID: PMC8683255.

Presenting Author

Chad Taylor

Poster Authors

Julia Morris

PhD

Government of Jersey Health & Community Services

Lead Author

Callum Gray MSc

Dclin

Government of Jersey Health & Community Services

Lead Author

Alessio Agostinis DClin

Government of Jersey Health & Community Services

Lead Author

Julie Le Cornu

MBBS

Castle Quay Medical

Lead Author

Sean Ryan

MBCHB

Route du Fort Medical

Lead Author

Chad Taylor

MB ChB FRCA FFPMRCA

Government of Jersey Health & Community Services

Lead Author

Topics

  • Treatment/Management: Pharmacology: Opioid