Primary care physicians are faced with treating a large proportion of chronic pain patients, but many do not often have specific training in the assessment and management of chronic pain, including the use of opioid medications for chronic pain management. Recognizing the significant role prescribers can play in reducing the risk of addiction, unintentional overdose, and death from the misuse and abuse of opioids, the U.S. Food and Drug Administration (FDA) has made prescriber education a central part of its Risk Evaluation and Mitigation Strategy (REMS) requirements for manufacturers of long-acting and extended-release (LA/ER) opioids.
With this in mind, Inflexxion's study investigated 1) what skills and training are considered to be needed for PCPs to prescribe opioids safely and effectively to patients with chronic pain, 2) what education would physicians find most relevant to clinical practice, and 3) what would resonate with them most.
The full report of this study, "Identifying Primary Care Skills and Competencies in Opioid Risk Management" was published in the Fall 2011 issue of The Journal of Continuing Education in the Health Professions.
Inflexxion researchers interviewed a panel of 16 nationally-known experts in primary care, pain management, and addiction about the knowledge and competencies they believed were most important for treating chronic pain safely and effectively in a primary care setting. Their responses were collated and analyzed using an online concept mapping program, which offers an innovative method of summarizing and prioritizing qualitative data.
Results showed the impressions of what skills PCPs thought their colleagues needed most, and those that pain and addiction specialists believed PCPs should have, diverged. While both groups agreed that the most important area for education was how to manage pain patients with comorbid conditions, PCPs were more concerned that their peers learn things like understanding aberrant drug-related behavior, how to monitor compliance to therapy, and how to ensure safe and appropriate prescribing of opioids than the specialists. Specialists placed greater emphasis on PCPs learning how to formulate a treatment plan, having a general understanding of chronic pain management, and being able to teach medication safety to patients.
"Primary care physicians treat a high proportion of chronic pain patients but often lack training about how to assess and address issues associated with prescribing opioids when they are an appropriate component of therapy. The result may be that they could avoid treating these patients, which can lead to an under treatment of pain," says Kevin Zacharoff, MD, Vice President of Medical Affairs for Inflexxion and co-author of this study. "As pharmaceutical manufacturers and educators move forward on developing educational programs with the goal of meeting FDA concerns about the safe use of opioids, understanding the skills and competencies needed in primary care can have a tremendous positive impact on public health."