Opioids, Chronic Pain, and Addiction in Primary Care

Declan T. Barry, Kevin S. Irwin, Emlyn S. Jones, William C. Becker, Jeanette M. Tetrault, Lynn E. Sullivan, Helena Hansen, Patrick G. O'Connor, Richard S. Schottenfeld, David A. Fiellin
2010 Journal of Pain  
Research has largely ignored the systematic examination of physicians' attitudes towards providing care for patients with chronic non-cancer pain. The objective of this study was to identify barriers and facilitators to opioid treatment of chronic non-cancer pain patients by officebased medical providers. We used a qualitative study design using individual and group interviews. Participants were twenty-three office-based physicians in New England. Interviews were audiotaped, transcribed, and
more » ... tematically coded by a multidisciplinary team using the constant comparative method. Physician barriers included lack of expertise in the treatment of chronic pain and co-existing disorders, including addiction; lack of interest in pain management; patients' aberrant behaviors; and physicians' attitudes toward prescribing opioid analgesics. Physician facilitators included promoting continuity of patient care and the use of opioid agreements. Physicians' perceptions of patient-related barriers included lack of physician responsiveness to patients' pain reports, negative attitudes toward opioid analgesics, concerns about cost, and patients' low motivation for pain treatment. Perceived logistical barriers included lack of appropriate pain management and addiction referral options, limited information regarding diagnostic workup, limited insurance coverage for pain management services, limited ancillary support for physicians, and insufficient time. Addressing these barriers to pain treatment will be crucial to improving pain management service delivery.
doi:10.1016/j.jpain.2010.04.002 pmid:20627817 pmcid:PMC2955997 fatcat:aosfeppdnzh2pf6mciz65wdaum