Office visits dedicated to chronic pain management lead to lower opioid use
More than a third of patients taking opioids who participated in mandatory office visits dedicated solely to nonmalignant pain management decided to stop using opioids, according to findings recently published in the Journal of the American Board of Family Medicine.
“We are not aware of anyone publishing results of a mandatory, structured approach to management of nonmalignant chronic pain with opioids that involved visits dedicated solely to management of this single issue,” Kevin S. McCann, MD, associate professor, family and community health, Marshall University Joan C. Edwards School of Medicine in Huntingdon West Virginia, told Healio Family Medicine.
Researchers asked 32 patients in a rural area to switch to a new care system. These patients then had to choose between transferring care, slowly stop taking the opioids or stay on opioids. Those who stayed on the opioids had an office visit focused on nonmalignant chronic pain management every 3 months. During these visits, physicians verified the controlled substance contract; assessed mood, functional status and pain; computed the average morphine equivalents taken; took patients’ pain-targeted history and physical; screened urine; and confirmed board of pharmacy monitoring.
McCann and colleagues found that 12 of the patients chose to slowly stop taking the opioids, 17 continued opioid medication, and three transferred care. The mean morphine equivalent mg per day was the most important prime determinant for ability to wean (17.01 mg/day) compared with maintaining (30.61 mg/day) (P =.0397; 95% CI, 0.68–26.51). Patients who chose to maintain opioid treatment had no signicant change in any measured criteria during the entire evaluation period.
“Showing that you can have 38% of patients choose themselves to stop opioid use is a good thing,” McCann said in the interview. “This can enable providers to engage in a process that they know has some impact on the major opioid problem. It can also reduce provider angst in regards to meeting regulatory requirements. It also can serve as a means to unburden primary care physicians who are dealing with multiple chronic health problems by allowing them to dedicate a visit solely to one issue. The combined elements of reducing burden, reducing angst and the feeling of making a difference in a major problem can potentially help reduce physician burnout.”
“This was a small study done in a single practice. It would be very interesting to see if these results could be reproduced on a larger scale and thus determine if they are generalizable,” he added. - by Janel Miller
Disclosure: The authors report no relevant financial disclosures.