Examining relationships between clinician attitudes about chronic pain and opioid prescribing rates

Dobscha SK, Flores JA, Leibowitz RQ, Cockrell E, Gerrity MS. Examining relationships between clinician attitudes about chronic pain and opioid prescribing rates. Poster session presented at: Academy of Psychosomatic Medicine Annual Meeting; 2006 Nov 16; Tucson, AZ.

Purpose: Previous surveys of clinicians suggest that pain-related knowledge, demographic factors, and fears of regulatory scrutiny or of contributing to addiction can influence opioid prescribing. The objectives of this study were to identify attitudes of Veterans Affairs (VA) primary care clinicians regarding chronic, non-malignant pain treatment, and to examine relationships between attitudes and opioid prescription rates. Methodology: Forty-two VA primary care clinicians were recruited to participate in a randomized trial of an intervention for chronic pain and depression. Thirty-eight clinicians completed a 22-item survey at study entry that included items regarding pain-related attitudes and behaviors, helpfulness of pain treatment modalities, satisfaction with resources, and job satisfaction. Opioid prescribing rates were obtained from a local pharmacy database. Multivariable linear regression was used to model relationships between survey responses and opioid prescribing rates. Results: Eighty-one percent of clinicians felt confident in their abilities to treat chronic pain, and 78% rated skilled pain management as a high priority. However, 70% reported dissatisfaction with their abilities to provide optimal pain treatment. Sixty-eight percent acknowledged fears of contributing to physical dependence on opioids, and 40% reported fears of regulatory scrutiny. Weight management, non-opioid analgesics, opioids, and physical therapy were rated as the most helpful treatments. The mean proportion of patients in clinicians’ panels prescribed opioids (PPPO) was .164 (sd = .068, range .066 to .373). In the final model, clinician background (physician vs. nurse practitioner or physician assistant) and job satisfaction were significantly and positively associated with PPPO (p = .004; p = .024, respectively). Conclusions: The discrepancy between clinician confidence and interest in treating pain and dissatisfaction with being able to provide optimal treatment indicates a need for more system support. There is considerable variation in rates of prescribing of opioids within this single setting. Finally, the relationships between job satisfaction, clinical background, and opioid prescribing merit additional investigation.