Physicians' pain management confidence versus competence

To assess awareness of existing pain management guidelines and compare physicians' confidence versus competence in selected pain management skills.

Prospective survey study.

A large urban tertiary medical center.

All Department of Medicine interns, senior residents, and attending physicians were sent a questionnaire; the overall response rate was 30 percent (91/304).

The questionnaire assessed physicians' awareness of the institution's pain management guidelines, their self-reported comfort level (confidence) with, and a knowledge assessment (competence) of three pain management skills (managing chronic-continuous pain, equianalgesic dose conversion, and managing breakthrough pain) using validated, standardized case vignettes.

A comparison of physicians' confidence with their competence in these pain management skills.

A total of 23 percent (21/91) of the respondents reported an awareness of the institution's pain management guidelines. Interns were significantly less confident than senior residents in all three pain management skills (p < 0.001, 0.006, 0.02) but nonsignificantly more competent in two of three skills (chronic-continuous pain, dose conversion). Attendings were generally more confident and nonsignificantly more competent than senior residents in all three pain management skills.

The underutilization of the pain management guidelines illustrates that the mere existence of these resources as a means of ensuring optimal pain management is insufficient. Creative pain management educational initiatives are needed to address the disparity between physician confidence and competence.