PALM SPRINGS, CALIF. – Balancing pain relief against gastrointestinal side effects of opioid analgesics in treating acute pain is a major challenge, a nationwide survey of nearly 6,000 physicians suggests.
A total of 70% of physicians said they "usually" or "often" prescribe opioid analgesics for patients with moderate to severe acute pain. Alongside that, 63% said they also "usually" or "often" prescribe or recommend treatments to manage opioid-related side effects, especially GI side effects, Dr. Bill H. McCarberg and his associates reported in a poster presentation at the annual meeting of the American Academy of Pain Medicine.
The survey also found that 65% of physicians said that patients who receive opioid analgesics for acute pain also take over-the-counter or prescription treatments to manage opioid-related GI side effects. A total of 20% of physicians rated unacceptable GI side effects as the top reason for discontinuing opioid analgesics, and 60% said GI side effects were the top or second-to-the-top reason for discontinuing opioids, reported Dr. McCarberg, a family physician and pain specialist at Kaiser Permanente, San Diego.
The data came from the Physicians Partnering Against Pain survey, which asked 5,982 physicians to identify 10-15 "typical patients who were returning for their first follow-up visits after treatment for moderate to severe acute pain. A majority of respondents (52%) were primary care physicians, 25% were pain specialists, and 23% were other medical specialists.
In all, 55% of physicians ranked unacceptable GI or other side effects as the most common reason patients discontinued opioids. More than 40% of physicians said that patients discontinued opioids, mainly because they believed that their pain had dissipated.
More than 15% of physicians said that they see more than 60 patients with moderate to severe pain in a typical week. More than 20% said they see 31-60 patients per week, more than 35% said they see 16-30 patients per week, and nearly 25% said they see 0-15 patients with moderate to severe pain in a typical week. A majority of physicians (55%) reported that more than 75% of their patients return for a follow-up visit after the initial acute pain treatment.
The participating physicians may not be representative of all U.S. practicing physicians, and there may be some recall bias affecting how well the results represent actual physician behavior.
Despite these limitations, the findings reflect the significant challenges that opioid-related side effects pose for managing moderate to severe acute pain, Dr. McCarberg said.
Janssen Scientific Affairs funded the study and Dr. McCarberg’s associates in the study were Janssen employees. Dr. McCarberg reported having no financial disclosures.