Pain Management Series

Click on a question to view poll results

Rate the following statements on a scale of 1 to 4 (1 = strongly disagree, 2 = disagree, 3 = agree, and 4 = strongly agree)

I am generally reluctant to make a diagnosis of fibromyalgia.
Results from 121 respondents:

1
12.4%

2
28.9%

3
33.1%

4
25.6%

There is a lot of controversy about whether fibromyalgia is a real diagnosis.
Results from 122 respondents:

1
8.2%

2
31.1%

3
45.1%

4
15.6%

I find it challenging to accurately diagnose fibromyalgia.
Results from 120 respondents:

1
6.7%

2
25.0%

3
47.5%

4
20.8%

I would like assessment tools to help me make the diagnosis of fibromyalgia.
Results from 119 respondents:

1
10.1%

2
13.4%

3
42.9%

4
33.6%

Dealing with patient misconceptions about fibromyalgia is a key issue in my practice.
Results from 120 respondents:

1
10.0%

2
35.8%

3
40.8%

4
13.3%

Do you use the PHQ-9 as a depression screening tool in your practice?
Results from 96 respondents:

Yes, I use this tool to screen for and monitor depression in my chronic pain patients.
16.7%

Yes, I use this tool to screen my chronic pain patients for depression but do not use it to monitor them.
7.3%

Yes, I use this tool to screen chronic pain patients who are not responding to treatment.
5.2%

No, I do not use the PHQ-9 in my practice.
70.8%

Do you use a pain intensity scale (eg, 0-10 scale) as a monitoring tool in your chronic pain patients?
Results from 94 respondents:

Yes, I use a pain scale at each visit to assess and guide management decisions.
51.1%

I use a pain scale periodically to assess and guide management decisions.
22.3%

No, I only use a pain scale initially to determine baseline pain severity.
9.6%

No, I do not use this type of tool in my practice.
17.0%

For patients who have chronic pain AND major depressive disorder, how would you generally approach treatment?
Results from 100 respondents:

First treat the pain, and then reassess the depression to see whether it still requires treatment.
13.0%

First treat the depression, and then reassess pain to see whether it still requires treatment.
7.0%

Treat both the pain and depression simultaneously.
75.0%

Treat the depression, and refer the patient to a pain specialist.
0%

Treat the pain, and refer the patient to a mental health specialist.
5.0%

What percentage of your patients have a chronic pain diagnosis?
Results from 102 respondents:

0-10%
14.7%

11-24%
46.1%

25-50%
20.6%

51-75%
10.8%

76-100%
7.8%

What percentage of your patients have a current diagnosis of depression?
Results from 94 respondents:

0-10%
13.8%

11-24%
45.7%

25-50%
28.7%

51-75%
10.6%

76-100%
1.1%

What percentage of your patients have co-existing chronic pain and depression?
Results from 91 respondents:

0-10%
19.8%

11-24%
44.0%

25-50%
20.9%

51-75%
13.2%

76-100%
2.2%

What are you most interested in learning about within the broad topic of chronic pain and depression?
Results from 108 respondents:

Reliably diagnosing depression in patients with chronic pain
1.9%

Principles of treating depression in patients with chronic pain
1.9%

Principles of treating depression and chronic pain simultaneously
23.1%

Appropriately prescribing pain medications in patients with chronic pain and depression – ''dos and don'ts''
73.1%

Which one of the following represents your most difficult challenge when managing coexisting pain and depression?
Results from 352 respondents:

Diagnosing depression in patients presenting with somatic complaints
18.2%

Cultural influences that can impact the presentation of depression
6.8%

Balancing treatment of the depression component and the pain component
35.5%

Medication selection
15.1%

Patient compliance/adherence
24.4%

Which of the following aspects of managing chronic pain do you find most challenging?
Results from 334 respondents:

Assessment and risk stratification
29.3%

Monitoring and reassessment
28.1%

Documentation
6.6%

Defining treatment goals
24.9%

Federal prescribing regulations
11.1%

An 84-year-old woman with hypertension and osteoarthritis is brought to the office by her daughter because of increasing joint pain from the osteoarthritis. The daughter notes that her mother is less able to care for herself and is less socially active. Previously the patient was able to control her pain with acetaminophen, 1000 mg q 6 hours as needed, but it is no longer enough. The pain is in her knees and hips and does not radiate. She says the pain is 2/10 at baseline but 8/10 with activity. She is feeling increasingly isolated and sad, and is having difficulty sleeping. Physical exam shows evidence of moderate to severe osteoarthritis of the hands, knees, and hips.

At this point, your plan is to:
Results from 166 respondents:

Stop the acetaminophen and begin ibuprofen, 800 mg tid as needed for pain.
15.7%

Continue the acetaminophen and add ibuprofen, 600 mg tid around the clock.
34.9%

Start acetaminophen/oxycodone (325 mg/10 mg), one to two tablets q 4 hours as needed for pain.
36.7%

Start controlled-release morphine, 15 mg bid.
12.7%

A 45-year-old male has been seeing you for chronic low back pain, sometimes with a burning sensation along his back and down his legs. Previous work-up showed mild spinal stenosis not amenable to surgery. The patient is a mechanic but has been out of work for 3 years. He had been taking acetaminophen/oxycodone (325 mg/5 mg), 2 tablets qid, but didn’t have adequate pain relief. You recently started him on controlled-release morphine, 15 mg bid, with the acetaminophen/oxycodone for breakthrough pain. The patient reports that his pain has improved from 10/10 to 5 or 6/10. He notes, however, that while he is sleeping better, he is sometimes still kept awake at night by his pain. Physical exam is normal.

At this point, your plan is to:
Results from 103 respondents:

Increase the dose of morphine from 15 to 30 mg bid.
7.8%

Start either duloxetine or imipramine.
20.4%

Add physical therapy and relaxation techniques to the treatment plan.
20.4%

All of the above.
51.5%

A 34-year-old male presents for his first visit with back and leg pain that began after a car accident 1 year ago. He describes his pain as 6/10 but says at times it’s 10/10. Lifting, prolonged activity, and sitting in one position make the pain worse. Patient reports that the back problem was previously diagnosed as musculoskeletal strain and sprain. He says he tried physical therapy for a few weeks but it was of no benefit. His previous physician gave him Percocet and it’s the only thing that helps. He’s almost out and wants a refill. Physical exam is normal.

At this point, your plan is to:
Results from 107 respondents:

Prescribe 1-month supply of acetaminophen/oxycodone and see him back in a month.
4.7%

Prescribe 1-week supply and try to obtain records from previous doctor and pharmacy.
36.4%

Explain that you cannot refill the narcotic until you obtain information from previous physician and pharmacy.
22.4%

Prescribe ibuprofen, 800 mg tid, and acetaminophen, 1000 mg qid, until you obtain information from previous physician and pharmacy.
36.4%

What is the biggest challenge you face in managing pain in the geriatric population?
Results from 238 respondents:

Assessing the patient for pain
18.9%

Drug interactions
23.9%

Dealing with co-morbid diseases
20.6%

Concerns about addiction
9.2%

Managing side effects
27.7%

Which one of the following represents your foremost challenge when dealing with chronic pain patients?
Results from 325 respondents:

How to streamline a pain assessment
24.0%

How to address frequent co-morbidities
10.5%

How to select effective therapies /combine therapies
39.4%

How to manage time spent on pain patients by doctor and staff
29.2%

 

 

 

 

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