Due to a lack of guideline-based direction for the management of chronic pain, selection of treatment is often based on institutional protocols, provider experience, and fear of legal issues, according to results of study presented at Pain Week 2017.

Online surveys were distributed nationally to US-practicing clinicians in different specialties actively managing ≥10 chronic pain patients per week. Data from 402 clinicians was collected and compiled for both descriptive and inferential analysis. Each respondent was presented with case vignettes, predominately centered on patients suffering from chronic pain due to osteoarthritis and low back pain. “These patient scenarios were designed to assess how clinicians prefer to manage, and case continuations were set up to progress the patient in pain severity,” the study authors explained. 

In the first vignette, a 52-year-old patient presented with a 4-month progression of moderate-to-severe right hip pain due to osteoarthritis. For this patient, most clinicians chose to prescribe an NSAID, corticosteroid injection, or non-pharmaceutical therapy followed by surgical referral as the patient progressed. The second case involved a 50-year-old patient suffering from chronic low back pain with inadequate relief from NSAIDs, muscle relaxants, or physical therapy. Results found that clinicians generally did not agree on the best treatment option for this patient, and a variety of NSAIDs and therapy involving short-acting opioids were generally recommended. In the third vignette, a 75-year-old patient presented with well-controlled hip osteoarthritis and was receiving oxycodone for the past 6 months. Results found that only a few clinicians recommended continuing opioid-based therapy instead of initiating a different treatment.

“Many clinicians, particularly orthopedic surgeons and rheumatologists, use standardized screening tools for opioid risk assessment,” the study authors commented. They added, “Of all clinicians included in the study, orthopedic surgeons and rheumatologists are least confident in their ability to assess patient risk and to assess a patient's level of pain.”

Results of this analysis found that guideline-based direction for management of chronic pain is lacking. The study authors added, “Continued studies are needed to understand practice change and allow refinement of educational messages.”

Read more of MPR's coverage of PAINWeek 2017 by visiting the conference page.