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Physicians Differ in Reasons for not Prescribing Opioids for Noncancer Pain
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Posted on: 11/28/2007
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The fear of addiction is often listed as a compelling reason to limit prescriptions of opioids. However, many doctors list insufficient knowledge of prescribing practice of opioids as a reason for limiting prescriptions.
Persistent noncancer pain (PNCP) is caused by many illnesses or disorders and can become quite disabling, affecting quality of life and other health issues. The authors of this study investigated prescribing practices of 132 physicians to identify the differing attitudes in prescribing opioids for noncancer pain.
A 26-item questionnaire was completed by the physicians. Among the group, 67 percent were house staff physicians and 33 percent were attending-level physicians. Internists made up the majority of the group (79 percent), the rest were geriatricians.
The questionnaire evaluated the physicians' knowledge of opioids and their use, and any barriers to prescribing them. The researchers found that about one quarter of all the physicians were hesitant to prescribe opioids because they were not sure of the proper dosages. The physicians most comfortable with the dosing were the geriatricians. A little more than half (58 percent) of physicians were concerned about side effects and this was for both internists and geriatricians.
Illegal diversion of the opioids was a concern for 31 percent of the physicians, although the geriatricians were less inclined to be concerned with this aspect. Finally, the prospect of being scrutinized for opioid prescription was a factor for about 20 percent of the physicians, particularly those who were house physicians.
When asked about their beliefs about chronic pain, almost all (90 percent) did agree that regular opioid use is the preferred method of pain relief. Patients were also often afraid of asking for pain relief for fear of addition (reported by 78 percent of the physicians). While more than half (57 percent) of the physicians felt that patients who had chronic pain would need more medications at higher doses than would patients with acute pain, 16 percent felt that there was a risk of the patient with chronic pain becoming addicted. In fact, 8 percent of the physicians stated that increasing opioid doses were an indication that the patient was becoming addicted to the medications.
Side effects of opioids can be serious and while geriatricians did not agree strongly, one third of the doctors in total felt that sedation is a common side effect of opioids.
The researchers pointed out that there were some significant differences between the prescription thoughts and practices of the internist and the geriatrician. While the internists had concerns about not being adequately knowledgeable about the correct dosages, illegal diversions, and addictions, the geriatricians were more concerned with not managing the pain properly due to under-reporting of pain by the patient.
The authors pointed out the limitations to the study included the small study size and that the study was done only at one institution. They concluded, however, that there are differing issues among the internists and geriatricians that should be addressed in order to better treat the patients with chronic noncancer pain.
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References:
Jenny J. Lin, MD, David Alfandre, MD, and Carlton Moore, MD. Physician Attitudes Toward Opioid Prescribing for Patients with Persistent Noncancer Pain. In Clinical Journal of Pain. November/December 2007. Vol. 23. No. 9. Pp. 812-820.
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