APS Press Room
News Highlights from The Journal of Pain • April 2006
The Peer Review Journal of the American Pain Society
| For immediate release | Contact: Chuck Weber (847) 705-1802 |
PATIENT ETHNICITY, GEOGRAPHIC LOCATION INFLUENCE PHYSICIAN PRESCRIBING OF OPIOID PAIN MEDICATIONS
“Opioid Prescriptions by US Primary-Care Physicians from 1992 to 2001”
Yngvild Olsen, Gail L. Daumit and Daniel E. Ford Johns Hopkins University School of Medicine
GLENVIEW, Ill., April 21, 2006 – Primary-care physicians (PCPs) usually are the first treatment option for patients with acute or chronic non-cancer pain. However, many PCPs avoid prescribing opioid pain medications due to concerns about addiction and potential legal and regulatory ramifications. Little is known about factors governing PCP prescribing of opioids, and this study analyzes trends and factors associated with opioid prescribing during PCP visits from 1992 to 2001. The objectives of the research were to determine the prevalence of opioid prescribing among PCPs and identify factors associated with opioid prescribing. Data were obtained from the annual National Ambulatory Medical Care Survey.
The authors reported opioids were prescribed for patients aged 18-65 in 52 of every 1,000 PCP visits during the ten-year period. The most common diagnoses for which an opioid medication was prescribed included back pain, acute musculoskeletal conditions and headache. It was noted in the study that in the beginning of the decade there was increased prescribing of opioids by PCPs, attributed to heavy marketing of OxyContin and other pain medications and greater emphasis on pain management in hospitals. In the latter part of the decade, the prevalence of opioid prescribing decreased, probably due to heightened physician fears of possible adverse legal consequences as the US Drug Enforcement Administration intensified investigations into physician opioid prescribing.
For the entire decade, there was an increase in opioid prescribing by PCPs, and key factors influencing PCP decisions to prescribe were the regional location of the practice, patient ethnicity, insurance status and length of the office visit.
Patients seeing PCPs in the Northeast and Midwest were less likely to receive opioids than in western states. The authors mentioned that many western states have passed laws permitting opioid prescribing for pain that also protect physicians from legal action for appropriate use of these medications. By contrast, many eastern and midwest states have triplicate prescription regulations for controlled substances, which inhibit physician willingness to prescribe them.
The authors also found that Hispanic patients were less likely to receive opioid prescriptions than whites. This disparity was found in all geographic regions. With regard to the insurance status and length of visit variables, Medicaid or Medicare patients were more likely to receive opioids than patients covered by an HMO, and there was a positive correlation between duration of the office visit and receiving an opioid prescription. It was noted that physicians who prescribe opioids may spend more time negotiating with patients who request opioids or looking for red flags that may impact the prescribing decision.
In concluding the article, the authors said the overall use of opioids by PCPs is relatively small compared to the millions of American suffering from chronic pain.
PAIN AFFECTS MOTHER-CHILD RELATIONSHIPS
“The Relationship Between Maternal Chronic Pain and Child Adjustment: The Role of Parenting as a Mediator”
Sahara Evans (Brunel University, UK), Edward A. Shipton (Christchurch School of Medicine, New Zealand) and Thomas Keenan (Niagara College, Canada)
Regardless of parental desires to spare children from their painful stresses, a child is vulnerable when witnessing distress and suffering of a parent. Research on mothers with depression has shown their children are at increased risk for psychological problems. In this study, 39 mothers with chronic pain with 55 children were compared to 35 pain-free mothers who had 48 children. It was hypothesized that mothers in the chronic-pain group would be more likely to employ dysfunctional parenting strategies, evidenced by increased over-reactivity, laxness, verbosity and a less warm and supportive relationship with their children.
Results showed that mothers with chronic pain were more likely to employ dysfunctional parenting strategies than pain-free mothers. Poor quality of the mother-child relationship correlated with child depression, poor physical health, internalizing and externalizing emotions and abnormal social behavior. Evans and her co-authors noted that only recently have children of chronic pain sufferers received attention, and this study shows that parenting strategies adopted by mothers with chronic pain have a significant influence on childhood emotional development.
KIDS WITH BACK PAIN AT RISK FOR PSYCHO-SOCIAL IMPAIRMENT
“Psychosocial Risks for Disability in Children with Chronic Back Pain”
Anne M. Lynch, Susmita Kashikar-Zuck, Kenneth R. Goldschneider and Benjamin A. Jones Cincinnati Children’s Medical Center
Though volumes of research have been dedicated to adults with low back pain, very little attention has been paid to pediatric back pain. It is estimated 40 to 69 percent of children will report back pain by adolescence and 7 percent of them will seek treatment for persistent pain. The authors of this study examined whether two risk factors, catastrophizing as a coping method and familial pain history, are associated with disability in pediatric back pain patients.
Evaluations of 65 patients showed that catastrophizing, characterized by worry, magnification of pain sensations and perceived lack of control over pain was the strongest predictor of disability. Catastrophizing also has been linked to disability in adult back pain patients. The authors concluded that in cases where family pain problems are documented and the child shows pain-related anxiety, clinicians may want to aggressively pursue comprehensive treatment plans to reduce disability and affect change before impairment becomes unmanageable.
NEUROPATHIC PAIN MORE WIDESPREAD THAN PREVIOUSLY THOUGHT
“The Epidemiology of Chronic Pain of Predominantly Neuropathic Origin, Results for a General Population Survey”
Nicola Torrance, Blair H. Smith, Michael Bennett and Amanda Lee University of Aberdeen, Scotland
No previously published studies have examined the overall prevalence of chronic, neuropathic pain in a general population. One study estimated the incidence at one percent and another reported 27 percent of patients at a pain clinic have neuropathic pain. Researchers surveyed 6,000 patients from two British primary care practices. Individuals with neuropathic pain were identified by affirmative answers to two questions. Are you currently troubled by pain or discomfort either all the time or on and off? Have you had this pain and discomfort for more than three months?
Results showed there was a population prevalence of neuropathic pain of 8.2 percent, which is much higher than previous estimates and accounts for 1 in 6 of those with chronic pain. Torrence and her co-authors concluded that neuropathic pain is more prevalent in the general population than previously thought, is more severe than other types of chronic pain, and affects the same population groups.