Treating Chronic Pain

Abstract

Background. Primary care physicians care for many chronic non-cancer pain (CNCP) patients, yet rarely utilize the Pain Medication Agreement (PMA) and the random Urine Drug Screen (UDS) as tools to monitor for adherence to therapy. We surveyed family medicine residents to describe their preparation for CNCP management, characterize their clinical encounters with CNCP patients, and document their current management practices. Methods . Family Medicine residents in a large academic medical center were surveyed about CNCP management using a 30-item instrument. This instrument was modified from previously conducted surveys. Univariate data were characterized by response rate. Results . Of the 24 residents who completed the survey, 54% perceived their residency training in CNCP management to be good and 96% of them rated patient care as a useful modality for preparation for CNCP management. When asked to characterize their encounters with CNCP patients, 59% of resident physicians perceived that visits with CNCP patients take longer. Only 25% found the care of CNCP patients rewarding and only a third of residents were as confident managing CNCP as diabetes. While all residents reported that the PMA was helpful when managing CNCP, only two residents reported having ordered a random UDS on all of their patients within the last six months. Conclusions . Although residents perceive the management of CNCP negatively, they reported good preparation for CNCP management. In addition, residents reported high utilization of the PMA. Use of the random UDS was surprisingly low. Further study is warranted to determine which educational modalities are linked to utilization of CNCP management strategies and what barriers and biases prevent adoption of the random UDS. KJM 2011; 4(1):1-5.