Prediction of outcome: Physicians opinions on chronic opioid therapy

Abstract

Current controversies with chronic opioid therapy may rest on the varying definition of successful and unsuccessful outcomes of opioid treatment among individual physicians. The purpose of this study is to develop descriptors for successful and unsuccessful outcomes with chronic opioid therapy. Three physician groups (pain specialists, primary care providers at a local community hospital, and a large teaching hospital) were surveyed by mail. The survey consisted of two parts: 1) questions about their belief in the effectiveness of chronic opioid therapy and open-ended questions relating to successful and unsuccessful outcomes, 2) a ratings section for possible indicators of unsuccessful chronic opioid treatment. An initial mailing of 250 questionnaires resulted in a response rate of 38%: pain specialists (67%) and non-pain specialists (33%). Pain specialists reported a greater number of patients on chronic opioid therapy compared with non-pain specialists (median 50 vs 5). Opinion regarding the effectiveness of chronic opioid therapy among all physicians was mixed (13% not effective, 44% unsure, 45% effective) and was not correlated with specialty or the number of patients physicians had on opioids. On the open-ended questions, good pain control (72%) and increased functionality (72%) were reported to be the most common successful outcomes. Poor pain control (51%), decreased functionality (43%), dose escalation (40%) and adverse effects (26%) were the most often reported unsuccessful outcomes. The ratings of the following descriptors varied: single loss of prescription; states preference for route of administration; patient reports an addiction problem; multiple stated allergies or adverse effects to non-opioid therapies; single ER visits; and recent suicide attempt. Although some disagreements exist among physicians as to what behaviors can be classified as aberrant, the majority of physicians consider improved functionality an equally important outcome as pain reduction, and a measure of the success of chronic opioid therapy. Current controversies with chronic opioid therapy may rest on the varying definition of successful and unsuccessful outcomes of opioid treatment among individual physicians. The purpose of this study is to develop descriptors for successful and unsuccessful outcomes with chronic opioid therapy. Three physician groups (pain specialists, primary care providers at a local community hospital, and a large teaching hospital) were surveyed by mail. The survey consisted of two parts: 1) questions about their belief in the effectiveness of chronic opioid therapy and open-ended questions relating to successful and unsuccessful outcomes, 2) a ratings section for possible indicators of unsuccessful chronic opioid treatment. An initial mailing of 250 questionnaires resulted in a response rate of 38%: pain specialists (67%) and non-pain specialists (33%). Pain specialists reported a greater number of patients on chronic opioid therapy compared with non-pain specialists (median 50 vs 5). Opinion regarding the effectiveness of chronic opioid therapy among all physicians was mixed (13% not effective, 44% unsure, 45% effective) and was not correlated with specialty or the number of patients physicians had on opioids. On the open-ended questions, good pain control (72%) and increased functionality (72%) were reported to be the most common successful outcomes. Poor pain control (51%), decreased functionality (43%), dose escalation (40%) and adverse effects (26%) were the most often reported unsuccessful outcomes. The ratings of the following descriptors varied: single loss of prescription; states preference for route of administration; patient reports an addiction problem; multiple stated allergies or adverse effects to non-opioid therapies; single ER visits; and recent suicide attempt. Although some disagreements exist among physicians as to what behaviors can be classified as aberrant, the majority of physicians consider improved functionality an equally important outcome as pain reduction, and a measure of the success of chronic opioid therapy.