Self-Reported Practices in Opioid Management of Chronic Noncancer Pain: A Survey of Canadian Family Physicians

Pain Research and Management, Sep 2018

BACKGROUND: In May 2010, a new Canadian guideline on prescribing opioids for chronic noncancer pain (CNCP) was released. To assess changes in family physicians’ (FPs) prescribing of opioids following the release of the guideline, it is necessary to know their practices before the guideline was widely disseminated.

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Self-Reported Practices in Opioid Management of Chronic Noncancer Pain: A Survey of Canadian Family Physicians

Pain Res Manag Self-reported practices in opioid management of chronic noncancer pain: A survey of Canadian family physicians Michael JM Allen MSc 0 Mark M Asbridge 0 Peter C MacDougall FRCPC 0 Andrea D Furlan 0 Oleg Tugalev FRCPC 0 0 MJM Allen, MM Asbridge, PC MacDougall, AD Furlan, O Tugalev. Self-reported practices in opioid management of chronic noncancer pain: A survey of Canadian family physicians. Pain Res Manag 2013;18(4):177-184 BACkgROunD: In May 2010, a new Canadian guideline on prescribing opioids for chronic noncancer pain (CNCP) was released. To assess changes in family physicians' (FPs) prescribing of opioids following the release of the guideline, it is necessary to know their practices before the guideline was widely disseminated. OBJeCTiveS: To determine FPs' practices and knowledge in prescribing opioids for CNCP in relation to the Canadian guideline, and to determine factors that hinder or enable FPs in prescribing opioids for CNCP. MeThODS: An online survey was developed and FPs who manage CNCP were electronically contacted through the College of Family Physicians of Canada, university continuing medical education offices and provincial regulatory colleges. ReSulTS: A total of 710 responses were received. FPs followed a precau - tionary approach to prescribing opioids and already practiced in accordance with Canadian guideline recommendations by discussing adverse effects, monitoring for aberrant drug-related behaviour and advising caution when driving. However, FPs seldom discontinued opioids even if they were ineffective and were unaware of the 'watchful dose' of opioids, the daily dose at which patients may need reassessment or closer monitoring. Only two of nine knowledge questions were answered correctly by more than 40% of FPs. The main enabler to optimal opioid prescribing was having access to a patient's opioid history from a provincial prescription monitoring program. The main barriers to optimal prescribing were concerns about addiction and misuse. COnCluSiOnS: While FPs follow a precautionary approach to prescribing opioids for CNCP, there are substantial practice and knowledge gaps, with implications for patient safety and costs. Chronic noncancer pain; Guidelines; Opioids; Pain management; Primary care surveys - Cestimated prevalence of which varies according to methodology and hronic noncancer pain (CNCP) is a major health problem, the settings. Recent data indicate that 25% of the general adult population ( 1,2 ) and 40% of seniors living in institutions (2) are affected by CNCP. Opioids are frequently prescribed to decrease pain and improve function in patients with CNCP ( 3 ). While evidence for the long-term efficacy of opioids in treating CNCP is weak, over the past several years, there has been a trend toward increased prescribing of opioids, particularly oxycodone and fentanyl. This trend has occurred in several countries ( 4-6 ), including the United States ( 7 ) and Canada ( 8 ), and has been accompanied by an increase in reported opioid abuse and deaths ( 8-11 ). In 2007, the medical regulatory authorities of all Canadian provinces formed the National Opioid Use Guideline Group (NOUGG). les pratiques autod?clar?es de prise en charge des opio?des en cas de douleurs chroniques non canc?reuses : un sondage aupr?s des m?decins de famille canadiens hiSTORiQ ue : En mai 2010, de nouvelles lignes directrices canadiennes sur la prescription d?opio?des pour soigner les douleurs chroniques non canc?reuses (DCNC) ont ?t? publi?es. Pour ?valuer les changements dans les habitudes de prescription d?opio?des des m?decins de famille (MF), il faut conna?tre leurs pratiques avant la diffusion g?n?ralis?e de ces lignes directrices. OBJeCTiFS : D?terminer les pratiques et les connaissances des MF ? l??gard de la prescription d?opio?des pour soigner les DCNC par rapport aux lignes directrices canadiennes et d?terminer les facteurs qui emp?chent ou incitent les MF ? prescrire des opio?des pour soigner des DCNC. M?ThODOlOgie : Les chercheurs ont pr?par? un sondage virtuel et pris contact par voie ?lectronique avec les MF qui traitent des DCNC par l?entremise du Coll?ge des m?decins de famille du Canada, des bureaux universitaires de formation m?dicale continue et des coll?ges provinciaux de r?glementation. R?Sul TATS : Les chercheurs ont obtenu un total de 710 r?ponses. Les MF respectaient une approche prudente ? l??gard de la prescription d?opio?des et respectaient d?j? les recommandations des lignes directrices canadiennes en abordant les effets ind?sirables, en surveillant les comportements aberrants li?s au m?dicament et en conseillant de faire preuve de prudence lors de la conduite. Cependant, les MF mettaient rarement fin au traitement aux opio?des m?me s?il ?tait inefficace et ne connaissaient pas la ? dose vigilante ? d?opio?des, c?est-?-dire la dose quotidienne ? laquelle les patients peuvent avoir besoin d?une r??valuation ou d?une surveillance plus (...truncated)


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Michael JM Allen, Mark M Asbridge, Peter C MacDougall, Andrea D Furlan, Oleg Tugalev. Self-Reported Practices in Opioid Management of Chronic Noncancer Pain: A Survey of Canadian Family Physicians, Pain Research and Management, 18, DOI: 10.1155/2013/528645