Primary Care Doctor: Should they be treating chronic pain patients



First off what is the difference between General Internist (Primary Care Doctor or PCP) and Internal Medicine doctors. General  Internists serve as primary care physicians, along with family medicine doctors and pediatricians. The biggest difference between Family Medicine and Internal Medicine is that Internal Medicine Doctors training focuses on adults, with residents spending time between various adult medicine subspecialties.

I know that all my Primary Care doctors (PCP) did not want to get involved with prescribing pain medications to me and always refered me back to my surgeon and/or a pain management doctor.  I always felt like they never wanted to get involved with my pain and treating it with opioid medications.

The Bio Med Center did a research study in where they wanted to study whether or not the doctor chooses to not prescribe pain meds or choose to prescribe pain medications to patients. Here is the background of this qualitative study:

“Primary care physicians struggle to treat chronic noncancerous pain while limiting opioid misuse, abuse, and diversion. The objective of this study was to understand how primary care physicians perceive their decisions to prescribe opioids in the context of chronic noncancerous pain management. This question is important because interventions, such as decision support tools, must be designed based on a detailed understanding of how clinicians use information to make care decisions.”

How was the study done?  It was  conducted in-depth qualitative interviews with family medicine and general internal medicine physicians until reaching the desired  themes. They used a funneling approach to ask a series of questions about physicians’ general decision-making challenges and use of information when considering chronic opioids. They then used an open-coding approach to identify and characterize themes in the data

The results of the study are as follows:

We interviewed fifteen physicians with diverse clinical experiences, demographics, and practice affiliations. Physicians said that general decision-making challenges in providing pain management included weighing risks and benefits of opioid therapies and time and resource constraints. Also, some physicians described their active avoidance of chronic pain treatment due to concerns about opioid risks. In their decision-making, physicians described the importance of objective and consistent information, the importance of identifying “red flags” related to risks of opioids, the importance of information about physical function as an outcome, and the importance of information that engenders trust in patients.

More and more PCP are denying or not even  prescribing pain meds at all.  It’s harder to see a PCP for pain and expect them to help by prescribing medications, even for short-term. It was hard a year ago to get anyone to want to help you by prescribing a pain medication but now that the CDC put out new guidelines, it’s even harder. So soon it will be harder to get pain meds anywhere.

I believe that PCP shouldn’t be prescribing pain meds and we should have more pain management doctors that take care of this only. PCP should treat the common cold and flu. Not saying that PCP doctors aren’t about to prescribe pain meds but if we get a handle on who is prescribing then maybe we wont have as much problems with abuse and over-prescribing medicines like pain meds.  Maybe just maybe we can get  control of the prescribing so that us with chronic pain only have a few doctors to deal with and only one for pain medicine.

Tell me your thoughts in the comment below and like this post if you would like to see more post done this way.


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