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. 2019 Jan 22:12:467-475.
doi: 10.2147/JPR.S168785. eCollection 2019.

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

Ruth White  1   2 , Chris Hayes  1 , Allison W Boyes  2   3 , Simon Chiu  3 , Christine L Paul  2   3
Affiliations

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

Ruth White et al. J Pain Res. .

Abstract

Background: General 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.

Aim: To 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 setting: In 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.

Methods: A 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.

Results: A 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.

Conclusions: Many 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.

Keywords: analgesics; attitude; chronic pain; general practice; opioid; prescriptions.

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Conflict of interest statement

Disclosure The authors report no conflicts of interest in this work.

Figures

Figure 1
Figure 1
Survey flowchart. Abbreviation: GP, general practitioner.
Figure 2
Figure 2
Oxycodone (strong) versus codeine (weak).
See this image and copyright information in PMC

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References

    1. Merskey H, Bogduk N, editors. Classification of Chronic Pain Descriptions of Chronic Pain Syndromes and Definitions of Pain Terms. 2nd ed. Seattle, WA: IASP Press; 1994.
    1. International Association for the Study of Pain Subcommittee on Taxonomy International Association for the Study of Pain. Classification of chronic pain. Descriptions of chronic pain syndromes and definitions of pain terms. Merskey H, editor. Pain. 1986;(Suppl 3):S1–S225. - PubMed
    1. Karanges EA, Blanch B, Buckley NA, Pearson SA. Twenty-five years of prescription opioid use in Australia: a whole-of-population analysis using pharmaceutical claims. Br J Clin Pharmacol. 2016;82(1):255–267. - PMC - PubMed
    1. Gisev N, Pearson SA, Blanch B, et al. Initiation of strong prescription opioids in Australia: cohort characteristics and factors associated with the type of opioid initiated. Br J Clin Pharmacol. 2016;82(4):1123–1133. - PMC - PubMed
    1. Dart RC, Surratt HL, Cicero TJ, et al. Trends in opioid analgesic abuse and mortality in the United States. N Engl J Med. 2015;372(3):241–248. - PubMed