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Analysis of the physician variable in pain management
C R Green1, J R Wheeler, B Marchant
1Department of Anesthesiology, University of Michigan Health System, University of Michigan, Ann Arbor, Michigan 48109, USA. carmeng@umich.edu
Background:
The role of physician variability in pain management is unknown.
Objective:
To assess the role of physician variability in the management of pain and provide quantitative data regarding the status of pain management in Michigan.
Design:
A multi-item mail survey was used to determine the physician's perceived knowledge of pain management modalities, goals, satisfaction, and confidence with pain treatment. Participants. The focus of this report was a group of 368 licensed Michigan physicians who provide clinical care.
Results:
Overall, 30% of the study group reported no formal education in pain management, although younger physicians reported more education (correlation coefficient = -0.252, P <.001). The physicians reported greater confidence in their knowledge of meperidine than other Schedule II opioids (P <.001 ). In regards to the opinion that prescribing strong opioids would attract a medical review, the physician responses ranged from 1 (strongly disagree) to 5 (strongly agree). The median score for this scale was 4, accounting for 46% of the responses. The study group expressed less satisfaction with their treatment of chronic pain as well as lower goals for relief (mean: 3.8; 95% confidence interval: 3.7-3.9).
Conclusions:
Lower expectations for relief and less satisfaction in its management may contribute to the undertreatment of chronic pain. Perceptions of regulatory scrutiny may contribute to suboptimal pain management. These preliminary data highlight physician variability in pain decision making while providing insights into educational needs.