The Role of Primary Care Provider Education on Chronic Pain Management in the United States

Problem Statement

The opioid analgesic therapy is regarded as one of the most effective treatment plans for managing chronic pain among non-cancer patients; however, primary care physicians remain inexperienced on safe and effective administration practices in opioid analgesic therapy (Trudeau et al., 2017). The incompetence of care providers and their lack of confidence to effectively administer opioid analgesics poses a significant threat to proper chronic pain treatment in the country (Jamison et al., 2014; Rudd et al., 2015; Trudeau et al., 2017). One of the measures that can be taken to address this challenge of inappropriate opioid administration for chronic pain management is to educate primary care providers on chronic pain management (White House Report, 2016). Comprehensive studies indicate that medical students who learn about acute pain management show improved confidence in administering pain management to non-cancer patients (Blake et al., 2015; Jamison et al., 2016; Trudeau et al., 2017). However, despite the presence of years of well-documented evidence on the inadequate availability of medical education in chronic pain management, interspersed with intermittent calls for improvement, most primary care physicians in the United States continue to receive little or no training from medical schools.

Literature Review

Unsurprisingly, primary care providers continually report growing dissatisfaction with their incompetence and limited knowledge to address chronic pain management, citing concerns on inadequate medical training preparation. A recent study conducted to determine the availability of chronic pain management education in medical training programs found that out of the 117 programs reviewed, only 4% have established chronic pain management curriculum; this is a significant deficit considering that specialty training is associated with improved chronic pain management (Jamison et al., 2016). Besides, surveys carried out among primary care providers highlight that several physicians remain reluctant to administer opioids as a chronic pain medication based on the concerns of accompanying adverse effects such as addiction, potential abuse, and the development of tolerance among their patients (Blake et al., 2015). In a survey conducted among medical residents, approximately three in every five rated the preparation provided by their medical schools in assessing chronic non-cancer patients as “poor” or “fair” (Pearson et al., 2017). Another research carried out in Massachusetts General Hospital among medical residents indicated that a total of 62 percent perceived that they were “unprepared” to treat opioid analgesic addiction (Davis & Carr, 2016). Among primary care providers, up to 46 percent highlighted that they received inadequate preparation from their medical education and training to addresses the challenge of opioid dependency, while 40 percent reported that their training was unsatisfactory in equipping them with competencies for chronic pain management (Pearson et al., 2016). Moreover, another study carried out among community health clinics established that more than four in five primary care providers rated that they received insufficient chronic pain management (Kavukcu et al., 2015).  These training deficits on chronic pain management education in medical schools directly correlate to physicians’ inability and limited knowledge to confidently provide comprehensive, evidence-based treatment for chronic pain (Davis & Carr, 2016).

Purpose of the Study

The purpose of this critical literature review study is to examine the relationship between the independent variable of primary care provider education on chronic pain management and its association with the dependent variable of appropriate administration of opioid analgesics for chronic pain management.

Research Questions and Hypothesis

Based on the measure of primary care providers’ perceptions, what is the association between primary care provider education on chronic pain management and appropriate administration of opioid analgesics for chronic pain management?

H₀ – Based on the measure of primary care providers’ perceptions, there is no statistically significant association between primary care education on chronic pain management and the appropriate administration of opioid analgesics for chronic pain management.

H₁ – Based on the measure of primary care providers’ perceptions, there is a statistically significant association between primary care education on chronic pain management and the appropriate administration of opioid analgesics for chronic pain management.

Methodology

This paper will be a qualitative research study that will use a critical literature review of secondary sources for data collection i.e., books, journal articles, and web pages on the topic of the “role of primary care education on chronic pain management in the United States.”

The Opioid-Focused Model will support this critical literature review. Opioids offer relief to numerous patients who suffer from non-cancer chronic pain, and they continue to receive increasing focus from evidence-based studies on the treatment of pain (Peppin, 2015). The opioid-focused model supports that opioids are sufficient to manage chronic pain, but should be administered under strict medical guidelines.

References

Blake, H., Leighton, P., van der Walt, G., & Ravenscroft, A. (2015). Prescribing opioid analgesics for chronic non-malignant pain in general practice – a survey of attitudes and practice. British Journal of Pain, 9(4), 225–232. https://doi.org/10.1177/2049463715579284

Davis, C., & Carr, D. (2016). Physician continuing education to reduce opioid misuse, abuse, and overdose: Many opportunities, few requirements. Drug and Alcohol Dependence, 163, 100-107. https://doi.org/10.1016/j.drugalcdep.2016.04.002.

Jamison, R.N., Sheehan, K.A., Scanlan, E., Matthews, M., & Ross, E.L. (2014). Beliefs and attitudes about opioid prescribing and chronic pain management: Survey of primary care providers. J Opioid Manag, 106: 375–82.

Jamison, R.N., Scanlan, N.P., Matthews, M., Dylan, C., & Ross, E.L. (2016). Attitudes of primary care practitioners in managing chronic pain patients prescribed opioids for pain: a prospective longitudinal controlled trial. Pain Medicine, 17(1): 99–113. https://doi.org/10.1111/pme.1287

Kavukcu, E., Akdeniz, M., Avci, H.H., Altuğ, M., Öner, M. (2015). Chronic non-cancer pain management in primary care: family medicine physicians’ risk assessment of opioid misuse. Postgrad Med, 127(1):22-26. https://doi.org/10.1080/00325481.2015.993572.

Pearson, A. C., Eldrige, J. S., Moeschler, S. M., & Hooten, W. M. (2016). Opioids for chronic pain: a knowledge assessment of nonpain specialty providers. Journal of pain research, 9, 129–135. https://doi.org/10.2147/JPR.S98273

Pearson, A. C., Moman, R. N., Moeschler, S. M., Eldrige, J. S., & Hooten, W. M. (2017). Provider confidence in opioid prescribing and chronic pain management: results of the Opioid Therapy Provider Survey. Journal of pain research, 10, 1395–1400. https://doi.org/10.2147/JPR.S136478

Peppin, J. (2015). Review article the complexity model: a novel approach to improve chronic pain care. Pain Medicine, 16: 653–666.

Trudeau, K.J., Hildebrand, C. Garg, P., Chiauzzi, E., & Zacharoff, K.L. (2017). A randomized controlled trial of the effects of online pain management education on primary care providers. Pain Medicine, 18(4): 680–692. https://doi.org/10.1093/pm/pnw271

Webster, L.R. (2016). Chronic Pain and the Opioid Conundrum. Anesthesiol Clin, 34(2):341-355. https://doi.org/10.1016/j.anclin.2016.01.002

White House Report. (2016). Epidemic: Responding to America’s prescription drug abuse crisis. Retrieved from: https://www.whitehouse.gov/sites/default/files/ondcp/policy-and-research/rx_abuse_plan.pdf.