Chronic Pain and The Prescription Opioid Overdose Epidemic: Addressing Provider Attitudes and Concerns

Chronic pain affects over 100 million Americans and efforts to improve pain control have led to an epidemic of prescription opioid related overdose deaths. Primary care providers manage the majority of chronic pain patients in the United States but the care provided is highly variable and often a source of frustration for providers and patients. The purpose of this literature review is to examine primary care physicians’ attitudes and practice behaviors regarding chronic pain and prescription opioid medications in order to focus educational interventions toward the needs of those distributing opioids and managing the chronic pain of the United States’ population. The main limitations of this review are that physician self-report may not represent true practice behaviors and that the majority of studies identified are cross-sectional and therefore cannot causally link provider education to patient and population outcomes. This review demonstrates that primary care physicians feel their formal education and training in pain management was inadequate and they fear that regulatory scrutiny substantially affects the way they practice medicine. Overall, there are clear needs to: (1) establish straightforward guidelines for pain management to reduce practice variability, (2) implement formal requirements for residency training in primary care regarding pain management and opioid medications, and (3) engage the legal and medical communities to collaborate when implementing policy changes.