Elsevier

Osteopathic Family Physician

Volume 3, Issue 4, July–August 2011, Pages 141-148
Osteopathic Family Physician

Review article
Barriers to managing chronic pain: perspectives of Appalachian providers

https://doi.org/10.1016/j.osfp.2010.07.003Get rights and content

Objective

Chronic pain is an important cause of morbidity among adults worldwide. Its management presents a greater challenge in the unique demographic of Appalachia. “Physician reluctance to prescribe opioids” has been identified as a major barrier to effective management of chronic pain nationally. The aim of this study was to determine whether prescribers in Appalachian Ohio encountered similar barriers as prescribers elsewhere.

Methods

A 29-item questionnaire was distributed to all 1719 physicians practicing in 29 counties in Ohio designated as “Appalachia.” The questionnaire evaluated demographics, assessed aspects of pain management, and asked participants to rank a list of 11 perceived barriers to effective chronic pain management.

Results

The overall survey return rate was 25.9%. The average respondent was male, 51 years old, with 20 years of experience practicing medicine, spending 86% of the working week with patients. Most participants (72.5%) reported being involved with chronic pain management “several times each week” or more. Of the potential barriers, those identified as important were (1) patient reluctance to make lifestyle or behavioral changes, (2) inadequate access to pain specialists, (3) inadequate access to health care because of financial burden, (4) lack of an objective measurement of pain, and (5) physician reluctance to prescribe opioids.

Conclusion

Prescribers in Appalachian Ohio identified issues of patient behaviors and health care accessibility as important barriers, in addition to top barriers previously described in the literature. Further research must be done to determine whether these results are unique to Appalachian populations.

Section snippets

Sample

The sample for this study consisted of a convenience sample of 1719 physicians from Ohio's Appalachian counties obtained from the Ohio State Medical Board in May 2007. All allopathic and osteopathic physicians who were in active practice at the time of the study and had a license to prescribe medication were included. A survey was mailed to listed addresses and, if returned, data were compiled and the participant removed from the mailing list. Three weeks after the initial questionnaire and

Response

Forty-eight surveys (2.8%) were returned undeliverable and 77 surveys (4.5%) were returned blank for a variety of self-reported reasons (i.e., retired, not currently managing chronic pain patients, etc.). The final sample consisted of 413 usable questionnaires with an overall return rate of 25.9%.

Demographics

Physicians practicing in 27 of Ohio's 29 (93.1%) Appalachian counties were represented in the sample. About three-quarters (74.0%) of the respondents were male and the majority of respondents (68.9%)

Discussion

This study examined the perspectives physicians have regarding barriers to the effective management of chronic pain in Appalachian Ohio. It is clear that management of chronic pain provides challenges to health care providers as well as their patients. It was identified that prescribers in this demographic view elements of patient reluctance and health care inaccessibility, as well as physician barriers including reluctance to prescribe opioids, as important obstacles to effective management of

Conclusion

Chronic pain management is a problem for patients and health care providers in Appalachian Ohio. Major barriers to effective pain management including patient behaviors, limited access to pain specialists, financial burden of accessing health care, lack of an objective measurement of pain, and physician reluctance to prescribe opioids were identified in this study. Future research addressing the complexity of chronic pain, especially for unique populations such as Appalachia, is necessary.

Acknowledgments

The authors thank the Ohio University College of Osteopathic Medicine Department of Family Medicine and the Research and Scholarly Affairs Committee for their support of this research, Holly Raffle, Ph.D., from Ohio University's Voinovich School of Leadership and Public Affairs for statistical analysis, and Ben M. Appleby for his assistance in creating the map of Appalachia.

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