Evaluation of a Survey of Current Clinical and Opioid Prescribing Practices in the Treatment of Chronic Non Terminal Pain in Arizona

Abstract

Chronic non-terminal pain (CNTP) is defined as pain lasting longer than three months, serves no functional role in healing, lasts beyond normal tissue recovery time and is unresolved despite appropriate treatment. CNTP triggers a complex set of central nervous system responses and a decline in social function. Opioids have been used to treat moderate to severe pain when non-opioid analgesics have not been sufficient. Multiple factors have led to increased use and higher prescribing dosages of opioids to manage CNTP in primary care. Higher dosages of opioids are associated with higher risk of adverse events, including death. Nationally, between 1999 and 2011, opioid related deaths rose over 300%. In Arizona, 41% of drug mortality is attributed to opioids and in 2011, the state ranked fifth in the nation for opioid prescribing rates. Statewide, a multi-professional, multi-agency strategy has been initiated to address this problem. The impact evaluation of the prescribing initiative led by the Arizona Criminal Justice Commission has been positive but little information exists regarding prescribers' practice patterns, prescribers' knowledge of evidence based recommendations synthesized in the guidelines, or the barriers to safe opioid prescribing in Arizona. The Statewide Interprofessional Practice-Based Research Network (IP PBRN) identified chronic pain management as a top research priority during their planning conference in 2012. The purpose of this project was to create and formalize a survey, eliciting responses that describe current practice patterns and identify implementation barriers to evidence-based recommendations for prescribing and monitoring opioids for patients with CNTP in Arizona primary care settings.