An examination of the factors that influence the prescription and use of long-term opioid therapy in the treatment of chronic nonmalignant pain

The role of the health care professional in the inadequate treatment of pain has been widely documented for the last two decades. A variety of factors have been posited to account for these inadequacies including a lack of knowledge regarding pain management principles, barriers and ethical conflicts experienced by health care professionals during pain management, and an exaggerated fear regarding the use of opioid medications for both malignant and nonmalignant pain patients. More recent studies have also begun to focus on the impact of the nurse-physician professional relationship on pain management practices. This thesis, in a series of studies, examined health care provider knowledge, barriers to pain management, ethical conflicts and the nurse-physician relationship in order to investigate the impact of these variables on pain management practices within medical and community settings. The prescription and use of long-term opioid therapy for people who suffer from chronic nonmalignant pain was also examined with the view to gaining an understanding of the factors that impact on the prescription and use of opioids as a safe and effective form of treatment. An examination of knowledge levels revealed that nurses and physicians demonstrated deficits in their knowledge regarding pain management principles. Although the Tasmanian sample of nurses and physicians were found to have deficits in their knowledge of certain pain management principles, these deficits were smaller than those found in previous studies using non-Australian samples. Given that a lack of pain management knowledge creates a barrier to optimal pain management, and the current respondents were found to display such deficiencies, further research was conducted to investigate the types of barriers nurses and physician are exposed to during pain management. The results indicated that nurses and physicians encounter a variety of barriers when attempting to provide optimal pain management. Concern about the barrier created by the patient to professional ratio was linked to a number of employment characteristics including clinical unit and employment setting. The results of the investigation regarding barriers to pain management demonstrated the importance of an adequate level of consultation between nurses and physicians in that the relationship can have a significant impact on barriers to optimal pain management. Further investigation of the nurse-physician relationship during pain management revealed that the professional relationship between nurses and physicians may not always allow for optimal pain management. The most concerning finding was the perception of some physicians that the role of the nurse is not vital to effective pain management. The nurse-physician relationship was also found to impact on the experience of ethical conflicts during pain management experienced by nurses. The study found that nurses encounter a variety of ethical and professional conflicts when attempting to provide optimal pain management. The examination of the effectiveness and consequence of long-term opioid use for chronic nonmalignant pain revealed low levels of medication misuse and abuse and relatively low levels of concern regarding tolerance, withdrawal, or negative side effects. Opioid users were found to differ significantly from nonopioid users in relation to the number of pain sites identified, pain intensity, psychological symptomatology, coping styles, and pain beliefs. Opioid use was not found to influence participants' satisfaction with the patient-physician relationship but significantly impacted on the use of health care services. The findings of this thesis indicate that a variety of factors still exist, despite advances in research, that impact on the ability of the nurse or physician to manage pain adequately, maintaining the inadequate treatment of chronic nonmalignant pain.