Opioid prescribing for chronic nonmalignant pain in primary care: challenges and solutions

Advances in Psychosomatic Medicine
Yngvild Olsen, Gail L Daumit

Abstract

Evaluating and treating patients with chronic nonmalignant pain, especially with opioid medications, often causes discomfort on the part of primary care physicians. A number of patient-, physician-, and system-related issues converge to make treating chronic pain a complex matter. Patient-related issues include an inability to define a clear anatomic cause for patients' pain, comorbid psychiatric conditions, and past and current substance abuse. Physicians lack training on the appropriate evaluation and treatment of chronic nonmalignant pain, fear creating addicts, and often face intense pharmaceutical industry pressure to prescribe medications. A paucity of practical clinical practice guidelines, controversy over the effectiveness of opioids on chronic nonmalignant pain, and concern about potential legal and regulatory ramifications add to the complexity of caring for these patients. Possible multifaceted solutions exist to minimize provider discomfort and improve their ability to treat patients appropriately. Examples include comprehensive, practical multidimensional guidelines on the evaluation and treatment of chronic nonmalignant pain, Web-based teleconferenced consultations with subspecialists, reduced pharmaceutical pres...Continue Reading

Citations

Jul 1, 2006·Journal of General Internal Medicine·Carole C UpshurJudith A Savageau
Mar 16, 2012·Journal of Occupational and Environmental Medicine·Xuguang Grant TaoEdward J Bernacki
Apr 12, 2012·Substance Abuse : Official Publication of the Association for Medical Education and Research in Substance Abuse·Craig E KellerRichard D Blondell
Aug 9, 2016·Family Practice·Jeffrey F ScherrerPatrick J Lustman
Apr 19, 2006·The Journal of Pain : Official Journal of the American Pain Society·Yngvild OlsenDaniel E Ford

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