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Protecting Pain Patients. The Evaluation of a Chronic Pain Educational Intervention

Journal Article


Abstract


  • Introduction

    Advocacy and commercially funded education successfully reduced barriers to the provision of long-term opioid analgesia. The subsequent escalation of opioid prescribing for chronic noncancer pain has seen increasing harms without improved pain outcomes.

    Methods

    This was a one-group pretest-posttest design study. A multidisciplinary team developed a chronic pain educational package for general practitioner trainees emphasizing limitations, risk-mitigation, and deprescribing of opioids with transition to active self-care. This educational intervention incorporated prereadings, a resource kit, and a 90-minute interactional video case-based workshop incorporated into an education day. Evaluation was via pre- and postintervention (two months) questionnaires. Differences in management of two clinical vignettes were tested using McNemar’s test.

    Results

    Of 58 eligible trainees, 47 (response rate = 81.0%) completed both questionnaires (36 of whom attended the workshop). In a primary analysis including these 47 trainees, therapeutic intentions of tapering opioid maintenance for pain (in a paper-based clinical vignette) increased from 37 (80.4%) pre-intervention to 44 (95.7%) postintervention (P = 0.039). In a sensitivity analysis including only trainees attending the workshop, 80.0% pre-intervention and 97.1% postintervention tapered opioids (P = 0.070). Anticipated initiation of any opioids for a chronic osteoarthritic knee pain clinical vignette reduced from 35 (74.5%) to 24 (51.1%; P = 0.012) in the primary analysis and from 80.0% to 41.7% in the sensitivity analysis (P = 0.001).

    Conclusions

    Necessary improvements in pain management and opioid harm avoidance are predicated on primary care education being of demonstrable efficacy. This brief educational intervention improved hypothetical management approaches two months subsequently. Further research measuring objective changes in physician behavior, especially opioid prescribing, is indicated.

Authors


  •   Holliday, Simon (external author)
  •   Hayes, Chris (external author)
  •   Dunlop, Adrian (external author)
  •   Morgan, Simon (external author)
  •   Tapley, Amanda (external author)
  •   Henderson, Kim (external author)
  •   Larance, Briony
  •   Magin, Parker (external author)

Publication Date


  • 2017

Citation


  • Holliday, S., Hayes, C., Dunlop, A., Morgan, S., Tapley, A., Henderson, K., Larance, B. & Magin, P. (2017). Protecting Pain Patients. The Evaluation of a Chronic Pain Educational Intervention. Pain Medicine, 18 (12), 2306-2315.

Number Of Pages


  • 9

Start Page


  • 2306

End Page


  • 2315

Volume


  • 18

Issue


  • 12

Place Of Publication


  • United States

Abstract


  • Introduction

    Advocacy and commercially funded education successfully reduced barriers to the provision of long-term opioid analgesia. The subsequent escalation of opioid prescribing for chronic noncancer pain has seen increasing harms without improved pain outcomes.

    Methods

    This was a one-group pretest-posttest design study. A multidisciplinary team developed a chronic pain educational package for general practitioner trainees emphasizing limitations, risk-mitigation, and deprescribing of opioids with transition to active self-care. This educational intervention incorporated prereadings, a resource kit, and a 90-minute interactional video case-based workshop incorporated into an education day. Evaluation was via pre- and postintervention (two months) questionnaires. Differences in management of two clinical vignettes were tested using McNemar’s test.

    Results

    Of 58 eligible trainees, 47 (response rate = 81.0%) completed both questionnaires (36 of whom attended the workshop). In a primary analysis including these 47 trainees, therapeutic intentions of tapering opioid maintenance for pain (in a paper-based clinical vignette) increased from 37 (80.4%) pre-intervention to 44 (95.7%) postintervention (P = 0.039). In a sensitivity analysis including only trainees attending the workshop, 80.0% pre-intervention and 97.1% postintervention tapered opioids (P = 0.070). Anticipated initiation of any opioids for a chronic osteoarthritic knee pain clinical vignette reduced from 35 (74.5%) to 24 (51.1%; P = 0.012) in the primary analysis and from 80.0% to 41.7% in the sensitivity analysis (P = 0.001).

    Conclusions

    Necessary improvements in pain management and opioid harm avoidance are predicated on primary care education being of demonstrable efficacy. This brief educational intervention improved hypothetical management approaches two months subsequently. Further research measuring objective changes in physician behavior, especially opioid prescribing, is indicated.

Authors


  •   Holliday, Simon (external author)
  •   Hayes, Chris (external author)
  •   Dunlop, Adrian (external author)
  •   Morgan, Simon (external author)
  •   Tapley, Amanda (external author)
  •   Henderson, Kim (external author)
  •   Larance, Briony
  •   Magin, Parker (external author)

Publication Date


  • 2017

Citation


  • Holliday, S., Hayes, C., Dunlop, A., Morgan, S., Tapley, A., Henderson, K., Larance, B. & Magin, P. (2017). Protecting Pain Patients. The Evaluation of a Chronic Pain Educational Intervention. Pain Medicine, 18 (12), 2306-2315.

Number Of Pages


  • 9

Start Page


  • 2306

End Page


  • 2315

Volume


  • 18

Issue


  • 12

Place Of Publication


  • United States