Abstract
BackgroundThe use of opioid medications as treatment for chronic non-cancer pain remains controversial. Little information is currently available regarding healthcare providers' attitudes and beliefs about this practice among older adults. This study aimed to describe primary care providers' experiences and attitudes towards, as well as perceived barriers and facilitators to prescribing opioids as a treatment for chronic pain among older adults.MethodsSix focus groups were conducted with a total of 23 physicians and three nurse practitioners from two academically affiliated primary care practices and three community health centers located in New York City. Focus groups were audiotape recorded and transcribed. The data were analyzed using directed content analysis; NVivo software was used to assist in the quantification of identified themes.ResultsMost participants (96%) employed opioids as therapy for some of their older patients with chronic pain, although not as first-line therapy. Providers cited multiple barriers, including fear of causing harm, the subjectivity of pain, lack of education, problems converting between opioids, and stigma. New barriers included patient/family member reluctance to try an opioid and concerns about opioid abuse by family members/caregivers. Studies confirming treatment benefit, validated tools for assessing risk and/or dosing for comorbidities, improved conversion methods, patient education, and peer support could facilitate opioid prescribing. Participants voiced greater comfort using opioids in the setting of delivering palliative or hospice care versus care of patients with chronic pain, and expressed substantial frustration managing chronic pain.ConclusionsProviders perceive multiple barriers to prescribing opioids to older adults with chronic pain, and use these medications cautiously. Establishing the long-term safety and efficacy of these medications, generating improved prescribing methods, and implementing provider and patient educational interventions could help to improve the management of chronic pain in later life.
Highlights
The use of opioid medications as treatment for chronic non-cancer pain remains controversial
Provider concerns have been identified in prior studies that did not focus on older adults [4,5,6,7,8,9,10]. Concerns identified in these studies included the potential for patient addiction, tolerance and physical dependence [4,5,6,7,8,9,10]; abuse, misuse or diversion of opioid medications [4,5,9,10,11,12]; inadequate provider training [5,9,12,13,14]; patient harm from adverse effects [4,6,7,12]; and regulatory sanctions [5,6,7,9,10]
Physician Nurse practitioner Physicians (n = 23) with geriatric fellowship training, n (%) Mean number of years in practice, n More than 50% of time in direct patient care, n (%) More than 75% of patients above age 65, n (%)† Residence status of practice patients, (%) Independent Assisted-living Percentage of older patients with chronic pain, n (%)† 75% Percentage of older patients with chronic pain on an opioid, n (%)† 0-5% 6-15% 16-25% >25%
Summary
The use of opioid medications as treatment for chronic non-cancer pain remains controversial. Little information is currently available regarding healthcare providers’ attitudes and beliefs about this practice among older adults. This study aimed to describe primary care providers’ experiences and attitudes towards, as well as perceived barriers and facilitators to prescribing opioids as a treatment for chronic pain among older adults. The use of opioid medications to treat chronic non-cancer pain (hereafter referred to as chronic pain) in older patients remains controversial [1,2,3]. 80 years) suggested that opioids (vs nonselective and selective nonsteroidal anti-inflammatory medications) confer substantial risks when used to treat older adults with non-cancer pain disorders [3]. Little information is available regarding healthcare providers’ attitudes and practices regarding the use of opioids as a treatment for chronic pain in older adults. Concerns identified in these studies included the potential for patient addiction, tolerance and physical dependence [4,5,6,7,8,9,10]; abuse, misuse or diversion of opioid medications [4,5,9,10,11,12]; inadequate provider training [5,9,12,13,14]; patient harm from adverse effects [4,6,7,12]; and regulatory sanctions [5,6,7,9,10]
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