How well is chronic pain managed? Who does it well?

Abstract

Background. The variability in physician attitudes and goals for chronic pain relief and satisfaction with chronic pain management is unknown. Objectives. To provide quantitative data regarding the status of chronic pain management by Michigan physicians. To relate physician's goals for pain management to physician confidence, preferences, and satisfaction with their chronic pain care. Research Design. A prospective cohort study utilizing a survey with four chronic pain vignettes. Subjects. Three hundred and sixty-eight Michigan physicians who provide clinical care. Measures. Evaluate differences in chronic pain decision making based upon physician demographic characteristics, knowledge, and attitudes. Results. The respondents reported a high frequency of treating patients with chronic pain. However, many expressed generally low satisfaction and confidence in their treatment of chronic pain, as well as low goals for the relief of chronic pain. A large number of respondents selected the worst or a poor treatment option for the chronic pain vignettes. In particular, prescriptions of opioid analgesics were infrequent. Younger physicians and those with pain education were more likely to choose the best responses to the vignettes. Conclusion. Low pain relief goals and satisfaction with the management of chronic pain suggests the potential for its undertreatment. Our data highlight the variability in pain decision making and provide insight into the educational needs of physicians regarding chronic pain management.