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. 2022 Mar 1;34(3):474-488.
doi: 10.1097/JXX.0000000000000673.

Influence of provider type on chronic pain prescribing patterns A systematic review

Jacqueline Nikpour  1 , Michelle Franklin  2 , Nicole Calhoun  3 , Marion Broome  4
Affiliations

Influence of provider type on chronic pain prescribing patterns A systematic review

Jacqueline Nikpour et al. J Am Assoc Nurse Pract. .

Abstract

Background: Chronic pain affects 100 million Americans and is most often treated in primary care, where the health care provider shortage remains a challenge. Nurse practitioners (NPs) represent a growing solution, yet their patterns of chronic pain management are understudied. Additionally, prescriptive authority limitations in many states limit NPs from prescribing opioids and often exist due to concerns of NP-driven opioid overprescribing. Little evidence on NP pain management prescribing patterns exists to address these issues.

Objective: Systematic review, according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, to examine opioid and nonopioid prescribing patterns of physicians, NPs, and physician assistants (PAs) in primary care. Eligible studies scored ≥60% on the Joanna Briggs Institute Critical Appraisal checklist.

Data sources: Searches within PubMed, Embase, CINAHL, and Web of Science.

Conclusions: Three themes were elucidated: 1) opioid prescribing in primary care, 2) similarities and differences in opioid prescribing by provider type, and 3) nonopioid pain management strategies. All provider groups had similar opioid prescribing patterns, although NPs and PAs may be slightly less likely to prescribe opioids than physicians. Although some studies suggested that NPs/PAs had higher opioid prescribing rates compared with physicians, methodological flaws may undermine these conclusions. Evidence is also lacking on nonopioid prescribing patterns across disciplines.

Implications for practice: Nurse practitioner/PA prescriptive authority limitations may not be as effective of a solution for addressing opioid overprescribing as transdisciplinary interventions targeting the highest subset of opioid prescribers. Future research should examine prescribing patterns of nonopioid, including nonpharmacologic, therapies.

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Conflict of interest statement

Competing interests: The authors report no conflicts of interest.

Figures

Figure 1.
Figure 1.
Preferred Reporting Items for Systematic Reviews and Meta-analyses diagram
See this image and copyright information in PMC

References

    1. Alford DP, Lazure P, Murray S, Hardesty I, Krause JR, & White JL (2019). National trends in prescription opioid risk mitigation practices: Implications for prescriber education. Pain Medicine, 20(5), 907–915. 10.1093/pm/pny298 - DOI - PubMed
    1. American Association of Nurse Practitioners. (2020). NP fact sheet. https://www.aanp.org/about/all-about-nps/np-fact-sheet
    1. Association of American Medical Colleges. (2019). The complexities of physician supply and demand: projections from 2017 to 2032. https://aamc-black.global.ssl.fastly.net/production/media/filer_public/3...
    1. Avorn J, Everitt DE, & Baker MW (1991). The neglected medical history and therapeutic choices for abdominal pain. A nationwide study of 799 physicians and nurses. Archives of Internal Medicine, 151(4), 694–698 - PubMed
    1. Azad TD, Vail D, Bentley J, Han SS, Suarez P, Varshneya K, Mittal V, Veeravagu A, Desai M, Bhattacharya J, & Ratliff JK (2019). Initial provider specialty is associated with long-term opiate use in patients with newly diagnosed low back and lower extremity pain. Spine, 44(3), 211–218. 10.1097/brs.0000000000002840 - DOI - PubMed