<p>General practitioners and management of chronic noncancer pain: a cross-sectional survey of influences on opioid deprescribing</p>

Abstract

BackgroundGeneral practitioners’ (GPs) views about deprescribing prescription opioid analgesics (POAs) may influence the care provided for patients experiencing chronic noncancer pain (CNCP). There are limited data addressing GPs’ beliefs about deprescribing, including their decisions to deprescribe different types of POAs.AimTo determine the proportion of GPs who hold attitudes congruent with local pain stewardship, describe their deprescribing decisions, and determine whether type of POA influences deprescribing.Design and settingIn 2016, a cross-sectional survey of all GPs (n=1,570) in one mixed urban and regional primary health network (PHN) in Australia was undertaken.MethodsA mailed self-report questionnaire assessed agreement with local guidelines for treating CNCP; influences on deprescribing POAs and likelihood of deprescribing in a hypothetical case involving either oral codeine or oxycodone.ResultsA response rate of 46% was achieved. Approximately half (54%) of GPs agreed POAs should be reserved for people with acute, cancer pain or palliative care and a third (32%) did not agree that a medication focus has limited benefits for peoples’ long-term quality of life and function. Most (77%) GPs were less likely to deprescribe when effective alternate treatments were lacking, while various patient factors (eg, fear of weaning) were reported to decrease the likelihood of deprescribing for 25% of GPs. A significantly higher proportion of GPs reported being very likely to deprescribe codeine compared to the equivalent opioid dose of oxycodone for a hypothetical patient.ConclusionsMany GPs in the PHN hold attitudes at odds with local guidance that opioids are a nonsuperior treatment for CNCP. Attitudinal barriers to deprescribing include: a lack of consistent approach to deprescribing opioids as a class of drugs, perceived lack of effective treatment alternatives and patient fear of deprescribing. Therefore, the next step in this target population is to appropriately train and support GPs in how to apply the evidence in practice and how to support patients appropriately.

Does Offering Battlefield Acupuncture Lead to Subsequent Use of Traditional Acupuncture?

“…This is important because one of the key reasons patients continue to use opioids is because patients and providers have difficulty engaging in discussions about nonpharmacologic options. 9 This finding suggests there is likely indirect value associated with VHA’s national efforts to train providers in offering this service beyond its potential for short-term pain relief. 17 , 18 Our findings also highlight that ease of access to traditional acupuncture was strongly correlated with its use, which is not surprising.…”

“… 5 – 7 Many barriers remain to providing nonpharmacologic interventions, including patients wanting an immediate solution, 8 with many patients skeptical about nonpharmacologic alternatives and preferring to remain on opioids. 9 Introducing nonpharmacologic interventions in a way that supports patients trying these interventions is a critical step to their adoption.…”

Prescribers or Multidisciplinarians? An Evaluation of Brief Education for General Practitioners on Chronic Pain Management

“…In 2016, 19 GPs in New South Wales, Australia, and other primary health clinicians were invited to two workshops. These aimed to encourage deprescribing of POAs and referral to local MDTs to deliver regimes similar to specialist MDTs (White et al 2019). Eleven attitudinal items were assessed with an unvalidated questionnaire within a pre-/post-test design.…”

“…Most pain education supports referral to a multidisciplinary team (MDT) (White et al 2019) but this is usually impractical, with less than 0.2% of those with CP accessing them each year (Semple & Hogg 2012). GPs often deal with patients with CP-in fact, discussing pain in almost half of their consultations (Tai-Seale et al 2011).…”

Yonder: Obesity communication, opioid deprescribing, actinic keratosis, and artificial intelligence

“…In Australia, the use of opioid analgesics has quadrupled in the last two decades and a recent study in an Australian primary health network investigated influences on opioid deprescribing. 2 In a survey of GPs, only half agreed that opioid analgesics should be reserved for people with acute cancer pain or palliative care. GPs were less likely to deprescribe when effective alternative treatments were lacking, and various patient factors (for example, fear of weaning) were reported to decrease the likelihood of deprescribing.…”