Can Monitoring Programs Improve Chronic Pain Management in Primary Care?
Patient monitoring and pain specialist support can help primary care practitioners better manage their patients taking opioids for chronic pain.
For the management of chronic pain, monthly monitoring and support from pain specialists can benefit primary care providers and their patients, according to a study published in Pain Medicine.
For clinicians, the support increased their confidence in prescribing opioids for pain, the rate of identifying patients at risk for opioid misuse, and their satisfaction regarding communication with pain specialists. Patients reported increased opioid medication compliance and overall satisfaction with monthly monitoring.
The study included 56 primary care clinicians and 253 patients with chronic pain. At baseline, the researchers assessed the clinicians' knowledge of opioids, concerns about pain medication prescriptions, practice behavior, and attitude about managing chronic pain patients; they also assessed each patient's risk for opioid abuse. Every month for 6 months, patients were called to monitor their pain level and opioid compliance.
Clinicians were randomly assigned to either the experimental group or the control group. In the experimental group, clinicians received monthly patient summary reports with information on their pain, mood, activity levels, healthcare use, and results of an opioid compliance checklist. In the control group, clinicians received baseline risk assessment for their patients but did not receive the summary reports.
After 1 year, all clinicians in the study reported improvements in managing chronic pain patients, especially those in the experimental group. However, some clinicians, especially younger ones, still expressed a reluctance to prescribe opioids for chronic non-cancer pain.
"This study demonstrates the benefits of careful monitoring of chronic pain patients and the need for pain management support within the primary care setting so that clinicians can make informed treatment decisions and gain confidence in addressing the risks of opioid abuse," said Robert N. Jamison PhD, chief psychologist at the Pain Management Center at Brigham and Women's Hospital. "There is also evidence that improved communication among practitioners can increase adherence among chronic pain patients."
Jamison RN, Scanlan E, Matthews ML, et al. Attitudes of primary care practitioners in managing chronic pain patients prescribed opioids for pain: a prospective longitudinal controlled trial. Pain Med. 2016;17(1):99-113.