Chronic noncancer pain management in primary care: family medicine physicians' risk assessment of opioid misuse

Postgrad Med. 2015 Jan;127(1):22-6. doi: 10.1080/00325481.2015.993572. Epub 2014 Dec 25.


Objective: The majority of patients with chronic noncancer pain (CNCP) are managed in the primary care settings. The primary care family physician (PCFP) generally has limited time, training, or access to resources to effectively evaluate and treat these patients, particularly when there is the added potential liability of prescribing opioids. The aim of this study is to make a favorable change in PCFPs' knowledge, attitudes, and practices about opioid use in CNCP via education on assessment of the risk of opioid misuse.

Materials and methods: The universe of this cross-sectional study comprised 36 family physicians working at Family Health Centers affiliated to Antalya Provincial Directorate of Health who volunteered to participate in the study. Initially, a survey on patients risk assessment was performed in both intervention and control groups; whereas the intervention group received education on assessment of the risk of opioid misuse, the control group did not. The survey was repeated after 6 months and the intervention group underwent a core examination. Data obtained were analyzed with Statistical Package for the Social Sciences 18.0 statistics program. Intervention and control groups were compared. Additionally, pre- and post-education results of the intervention group were also compared.

Results: About 61.1% of family physicians reported concern and hesitation in prescribing opioids due to known risks, such as overdose, addiction, dependence, or diversion, and agreed that family physicians should apply risk assessment before opioid use in CNCP. Only 16.6% of PCFP reported that risk assessment is not so necessary, whereas 22.2% of PCFP were undecided. Although 47.2% of the family physicians expressed a willingness to apply risk assessment before starting opioids, the rate of eagerness increased markedly to 77.7% after the education, but the rate of increase in practicing was not statistically significant.

Conclusion: Knowledge and competency of the family physicians in managing CNCP were improved as was expected. Although the rate of eagerness about risk assessment of opioid misuse was increased, expected increase in the rate of using risk assessment was not achieved. Further studies are needed to identify the reasons of the difficulties on changing the attitudes and practices of primary care physicians about this subject.

Keywords: chronic pain; family medicine; opioids; risk assessment.

MeSH terms

  • Adult
  • Analgesics, Opioid / adverse effects
  • Analgesics, Opioid / therapeutic use*
  • Attitude of Health Personnel
  • Chronic Pain / drug therapy*
  • Cross-Sectional Studies
  • Female
  • Health Knowledge, Attitudes, Practice*
  • Health Surveys
  • Humans
  • Male
  • Middle Aged
  • Opioid-Related Disorders / epidemiology*
  • Pain Management
  • Physicians, Family*
  • Physicians, Primary Care
  • Practice Patterns, Physicians'*
  • Prescription Drug Misuse*
  • Primary Health Care
  • Risk Assessment


  • Analgesics, Opioid