TY - JOUR
T1 - Opioid prescribing for chronic nonmalignant pain in primary care
T2 - Challenges and solutions
AU - Olsen, Yngvild
AU - Daumit, Gail L.
PY - 2006
Y1 - 2006
N2 - Evaluating and treating patients with chronic nonmalignant pain, especially with opioid medications, often causes discomfort on the part of primary care physicians. A number of patient-, physician-, and system-related issues converge to make treating chronic pain a complex matter. Patient-related issues include an inability to define a clear anatomic cause for patients' pain, comorbid psychiatric conditions, and past and current substance abuse. Physicians lack training on the appropriate evaluation and treatment of chronic nonmalignant pain, fear creating addicts, and often face intense pharmaceutical industry pressure to prescribe medications. A paucity of practical clinical practice guidelines, controversy over the effectiveness of opioids on chronic nonmalignant pain, and concern about potential legal and regulatory ramifications add to the complexity of caring for these patients. Possible multifaceted solutions exist to minimize provider discomfort and improve their ability to treat patients appropriately. Examples include comprehensive, practical multidimensional guidelines on the evaluation and treatment of chronic nonmalignant pain, Web-based teleconferenced consultations with subspecialists, reduced pharmaceutical pressure, enhanced continuing medical education and pregraduate training, multispecialty coordinated care of patients with adequate reimbursement for such care, and physician access to state-based systems to track opioid prescriptions.
AB - Evaluating and treating patients with chronic nonmalignant pain, especially with opioid medications, often causes discomfort on the part of primary care physicians. A number of patient-, physician-, and system-related issues converge to make treating chronic pain a complex matter. Patient-related issues include an inability to define a clear anatomic cause for patients' pain, comorbid psychiatric conditions, and past and current substance abuse. Physicians lack training on the appropriate evaluation and treatment of chronic nonmalignant pain, fear creating addicts, and often face intense pharmaceutical industry pressure to prescribe medications. A paucity of practical clinical practice guidelines, controversy over the effectiveness of opioids on chronic nonmalignant pain, and concern about potential legal and regulatory ramifications add to the complexity of caring for these patients. Possible multifaceted solutions exist to minimize provider discomfort and improve their ability to treat patients appropriately. Examples include comprehensive, practical multidimensional guidelines on the evaluation and treatment of chronic nonmalignant pain, Web-based teleconferenced consultations with subspecialists, reduced pharmaceutical pressure, enhanced continuing medical education and pregraduate training, multispecialty coordinated care of patients with adequate reimbursement for such care, and physician access to state-based systems to track opioid prescriptions.
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U2 - 10.1159/000095371
DO - 10.1159/000095371
M3 - Article
C2 - 15248372
AN - SCOPUS:4544224188
SN - 0065-3268
VL - 25
SP - 138
EP - 150
JO - Advances in psychosomatic medicine
JF - Advances in psychosomatic medicine
ER -