PainRelief.com Interview with:
Debbie Feldman,, Ph.D.
Professeure titulaire/Full Professor
Faculté de médecine/Faculty of Medicine
École de réadaptation/School of Rehabilitation
Université de Montréal
PainRelief.com: What is the background for this study? What are the main findings?
Response: The goal was to explore clinical management of new cases of musculoskeletal conditions associated with chronic pain, at the population level. Few studies to date have addressed treatment at the population level and none explored initial management specifically. Furthermore, not much is known regarding patient and provider characteristics that are potentially associated with different treatment options (except for some information regarding prescription of opioids). Main findings are in the answer below.
PainRelief.com: What should readers take away from your report?
Response: In a representative sample of Americans with new cases of likely chronic musculoskeletal pain who sought care (2007-15), the most common treatment was medication prescription. Opioids were actually prescribed in over 1/5 of visits while nonpharmacologic options were used much less (10-15% of visits). The use of nonopioid medications increased with age whereas opioid prescription peaked in those between 25-64 years of age. Nonpharmacologic treatment prescription was highest for children and youth under 15. Physician specialty was associated with treatment choice with family practitioners more likely to prescribe opioids than internists, orthopedists and neurologists; the latter two groups were more likely to prescribe physical therapy as compared to family practitioners. Also, physicians using the electronic medical record (EMR) were more likely to prescribe opioids than those using paper records.
PainRelief.com: What recommendations do you have for future research as a result of this work?
Response: Since this population based study used data from 2007-2015, there would be a need to see whether there has been a subsequent decrease in opioid prescription due to the newer guidelines issued. The association between prescription of opioids and the use of the EMR may warrant some further attention. Other treatment options such as the use of medicinal cannabis was not included and should be investigated. Access to effective nonpharmacologic interventions needs to be assessed as these may not be covered by reimbursement plans.
Finally, physician knowledge,attitudes and beliefs regarding nonpharmacologic options would be important to research.
Management of patients with a musculoskeletal pain condition that is likely chronic: Results from a national cross sectional survey
Feldman, Debbie Ehrmann et al.
The Journal of Pain, Volume 0, Issue 0
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