Barriers to Using Nonpharmacologic Approaches and Reducing Opioid Use in Primary Care

Giannitrapani, Karleen F.; Ahluwalia, Sangeeta C.; McCaa, Matthew; Pisciotta, Maura; Dobscha, Steven K.; Lorenz, Karl

doi:10.1093/pm/pnx220

Cited by 34 publications

(29 citation statements)

References 23 publications

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“…The challenges and supports participants experienced post-EVP are similar to those identified in Bair et al’s study of barriers and facilitators to pain management strategies after an interdisciplinary intervention26 and in studies of barriers and facilitators to nonpharmacological pain treatment 36–40. Veterans in our study echoed many of the same barriers that Veterans reported to Bair et al almost a decade ago.…”

Section: Discussionsupporting

confidence: 82%

<p>Qualitative evaluation of an interdisciplinary chronic pain intervention: outcomes and barriers and facilitators to ongoing pain management</p>

Penney¹,

Haro²

2019

JPR

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Background Many leaders in the field of chronic pain treatment consider interdisciplinary pain management programs to be the most effective treatments available for chronic pain. As programs are instituted and expanded to address demands for nonpharmacological chronic pain interventions, we need to better understand how patients experience program impacts, as well as the challenges and supports patients encounter in trying to maintain and build on intervention gains. Methods We conducted a qualitative evaluation of an interdisciplinary chronic pain coaching program at the Atlanta Veterans Affairs. A purposive sample of Veterans were engaged in interviews (n=41) and focus groups (n=20) to elicit patient outcomes and barriers and facilitators to sustainment of improvements. Transcripts were analyzed using matrix and thematic analyses. Results Veterans reported various outcomes. Most frequently they described adopting new self-care or lifestyle practices for pain management and health. They also often described accepting pain, being better able to adjust and set boundaries, feeling more in control, participating in life, and changing their medication use. A small portion of the sample reported no improvement in their conditions. When outcomes were examined as a whole, individuals described impacts that could be placed along a spectrum from whole life change to no change. Facilitators to maintenance of improvements included having building blocks (eg, carrying forward practices learned), support (eg, access to resources), and energy (eg, motivation), and improving incrementally. Challenges were not having building blocks (eg, life disruptions), support (eg, unknown follow-up options), and energy (eg, competing demands) and having an unbalanced rate of improvement. Conclusion Most Veterans identified experiencing multiple areas of improvement, especially learning about and taking up new pain and general health management skills. Ensuring participants can build on and find support for these outcomes when applying what they have learned in their dynamic social and physical worlds remains a challenge for this program and other relatively short-term interdisciplinary chronic pain interventions.

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Section: Discussionsupporting

confidence: 82%

<p>Qualitative evaluation of an interdisciplinary chronic pain intervention: outcomes and barriers and facilitators to ongoing pain management</p>

Penney¹,

Haro²

2019

JPR

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“…Another factor associated with prescribing treatments that were not perceived as being very useful might be the ease with which PCPs could prescribe drugs rather than other treatments. Drugs are immediately available, whereas referral to specialists for other treatments may imply a delay in patient care [ 32 , 34 , 51 ], even more so when treatments are not readily available or cannot be reimbursed by the conventional medical system [ 36 ]. However, these observations must be balanced by the fact that some treatments (such as opioids or spinal/nerve blocks) seem to have been prescribed by many PCPs, but to a small number of patients.…”

Section: Discussionmentioning

confidence: 99%

Primary care physicians’ attitude and reported prescribing behavior for chronic low back pain: An exploratory cross-sectional study

et al. 2018

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ObjectiveRecent guidelines for chronic or recurrent low back pain recommend non-pharmacologic treatments as first-line options. The objective of this study was thus to explore the perceived usefulness of several conventional and complementary medicine treatments for chronic or recurrent low back pain by primary care physicians and their reported prescribing behavior.DesignAn exploratory cross-sectional study.Setting and participantsPrimary care physicians of the French-speaking part of Switzerland.Main outcome measuresPrimary care physicians’ perceived usefulness of each conventional and complementary medicine treatment and their reported recommendation behavior were considered dependent variables in multivariate logistic regression models. All correlations were computed between binary variables, and phi coefficients were calculated to estimate correlation strengths.Results533 primary care physicians answered the questionnaire (response rate: 25.6%). The top 3 conventional treatments most often considered useful by primary care physicians for chronic or recurrent low back pain were physiotherapy (94.8%), nonsteroidal anti-inflammatory drugs (87.9%), and manual therapy (82.5%), whereas the most prescribed conventional treatments were physiotherapy (99.2%), nonsteroidal anti-inflammatory drugs (97.4%), and acetaminophen (94.4%). Osteopathic treatment (78.4%), yoga (69.3%), and therapeutic massage (63.9%) were the complementary medicine treatments most often considered useful by primary care physicians in managing chronic or recurrent low back pain. Being a female physician, younger than 56 years, trained in complementary medicine, or using complementary medicine were all associated with higher perceived usefulness of complementary medicine treatments in general. The most recommended complementary medicine treatments by primary care physicians were osteopathic treatment (87.3%), acupuncture (69.3%), and therapeutic massage (58.7%). Being a female physician, younger than 56, and using complementary medicine were all associated with more complementary medicine recommendation in general.ConclusionOur results highlight the importance of better understanding the prescribing patterns of primary care physicians for chronic or recurrent low back pain. Considering the frequency and burden of chronic or recurrent low back pain, programs focusing on the most (cost-) effective treatments should be implemented.

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“…For example, minority patients with chronic pain receive less patient education, medications, surgery, and specialty referrals [14]. Access to non-pharmacological therapies is challenging as these therapies are often located far from low income neighborhoods, require an out of pocket payment, may not be covered by health insurance, and are less likely to be offered as a treatment to low-income or under-represented minority patients [18–23].…”

Section: Introductionmentioning

confidence: 99%

Effectiveness of integrative medicine group visits in chronic pain and depressive symptoms: A randomized controlled trial

et al. 2019

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BackgroundCurrent treatment options for chronic pain and depression are largely medication-based, which may cause adverse side effects. Integrative Medical Group Visits (IMGV) combines mindfulness techniques, evidence based integrative medicine, and medical group visits, and is a promising adjunct to medications, especially for diverse underserved patients who have limited access to non-pharmacological therapies.

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Barriers to Using Nonpharmacologic Approaches and Reducing Opioid Use in Primary Care

Cited by 34 publications

References 23 publications

<p>Qualitative evaluation of an interdisciplinary chronic pain intervention: outcomes and barriers and facilitators to ongoing pain management</p>

<p>Qualitative evaluation of an interdisciplinary chronic pain intervention: outcomes and barriers and facilitators to ongoing pain management</p>

Primary care physicians’ attitude and reported prescribing behavior for chronic low back pain: An exploratory cross-sectional study

Effectiveness of integrative medicine group visits in chronic pain and depressive symptoms: A randomized controlled trial

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