Management of chronic noncancer pain by VA primary care providers: When is pain control a priority?

Objective:To examine how primary care providers (PCPs) prioritize management of chronic pain in patients with multiple chronic conditions and to determine PCP perspectives on chronic pain management and pain treatment resources. Study Design: Survey mailed to a random sample of 500 Department of Veterans Affairs (VA) PCPs at VA medical centers and community-based outpatient clinics. Methods: After reading a vignette describing a patient with multiple chronic conditions and chronic pain, PCPs were asked to identify the 3 most important issues to address during the visit. The survey also asked about the availability of services, and level of confidence and satisfaction with chronic pain management. Results: A total of 279 eligible PCPs (57%) responded to the survey, 77% of whom identified pain control among the top 3 treatment priorities. PCPs who did not choose pain control were more likely to indicate that chronic pain patients should see a specialist (54% vs 35%, P=.006) and were less confident about using opioid analgesics (52% vs 72%, P =.002). Of the respondents, 86% reported psychology or mental health clinics were available at their clinic site; 71%, physical therapy; and 20%, multidisciplinary pain clinics. Most PCPs (74%) were satisfied with the quality of care they provide for patients with chronic pain but only 30% were satisfied with access to pain specialty services. Conclusion: Additional training opportunities for PCPs and more effective use of ancillary services may be needed for further improvements in care for chronic pain patients.