For treating the estimated 100 million Americans with chronic pain -- a population larger than those with heart disease, cancer and diabetes combined -- research reported in The Journal of Pain shows that primary care physicians overwhelmingly prefer to prescribe non-steroidal anti-inflammatory medications (NSAIDS), in accordance with published clinical practice guidelines.
The Journal of Pain is the peer review publication of the American Pain Society.
Researchers at the University of Missouri Kansas City School of Pharmacy, Children’s Mercy Hospital, Kansas City and University Health System, San Antonio, studied factors, variations and current treatment practices in the management of chronic non-cancer pain and sought to determine if these practices are consistent with various clinical practice guidelines. The researchers utilized data from more than 690,000 patient visits to physician offices compiled for the National Ambulatory Medical Care Survey from 2000 to 2007. The sample included patients 18 and older with common non-malignant chronic pain.
The authors found than chronic pain related physician office visits comprised 13 percent of total national ambulatory care visits, of which 45 percent involved primary-care physicians. Only 0.12 percent of the visits involved pain specialists. The authors noted this disparity shows that the demand for pain services far exceeds availability due to the limited number of pain specialists practicing in the United States.
With regard to pain medicine prescribing practices, the authors reported that, in compliance with published guidelines, non-steroidal anti-inflammatory drugs were with most common medication class prescribed as a first-line option. NSAID use was surprisingly high with rates of 97 to 99 percent in all chronic pain types studied. Acetaminophen use was very low at 4 percent. The authors surmised that many chronic pain patients have not achieved sufficient pain relief from acetaminophen by the time they decide to see a doctor.
No other medication class was used in 26 percent or more of the study population, and there was a lower than anticipated utilization of opioid analgesics. They were prescribed for only 10.5 percent of the general pain group.
- Rafia S. Rasu, Rose Sohraby, Lindsay Cunningham, Maureen E. Knell. Assessing Chronic Pain Treatment Practices and Evaluating Adherence to Chronic Pain Clinical Guidelines in Outpatient Practices in the United States. The Journal of Pain, 2013; 14 (6): 568 DOI: 10.1016/j.jpain.2013.01.425
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