Care for Patients with Chronic Nonmalignant Pain with and without Chronic Opioid Prescriptions: A Report from the Cincinnati Area Research Group (CARinG) Network

Abstract

The use of chronic opioids for patients with chronic nonmalignant pain (CNMP) is a common problem for family physicians, yet little is known about the management of CNMP in family medicine offices. Twenty one physicians at 8 practices of the Cincinnati Area Research Group (CARinG) network completed 25 to 30 modified Primary Care Network Survey 2 surveys. Each survey contained the question, "To your knowledge, does this patient have chronic (>3 months) pain, even if they are not being seen for pain today?" Chart reviews of all patients identified as having chronic pain were performed to examine assessment, management, and monitoring of chronic opioids. Ten of these physicians and 10 office nurses or medical assistants were interviewed about caring for patients with chronic pain. Primary Care Network Survey 2 questionnaires were completed for 533 patients, 138 (26%) of which had CNMP, and 65 (47%) of those were taking chronic opioids; 25% of patients taking chronic opioids had a urine drug screen and 22% had an opioid contract in the chart. Patients with CNMP who were taking chronic opioids were more likely to be younger (54 vs 59 years; P = .003), have a coexisting mental health diagnosis (69% vs 44%; P = .005), and have assessments for pain (P = .031), function (P = .003), and psychological distress (P < .001) and a second opinion (P = .001) in the chart than did patients with CNMP who were not taking opioids. Physicians described suspicion of patients as a primary difficulty in prescribing or considering chronic opioids; they also expressed interest in practicing evidence-based CNMP care, but there was little teamwork between physicians and medical assistants caring for patients with CNMP who were taking chronic opioids. Chronic opioids are frequently prescribed to patients with CNMP. Although patients taking opioids have better documentation of pain assessments and management, care for all patients with CNMP fell short of evidence-based guidelines and was primarily performed by the physician alone.