The Interface Between Substance Abuse and Chronic Pain Management in Primary Care: A Curriculum for Medical Residents

ABSTRACT

Objectives: To develop and assess a housestaff curriculum on opioid and other substance abuse among patients with chronic noncancer pain (CNCP). Methods: The two-hour, case-based curriculum delivered to small groups of medical housestaff sought to improve assessment and management of opioid-treated CNCP patients, including those with a substance use disorder. A two-page pre-post survey was administered to assess self-efficacy change on a scale from 1 (strongly disagree) to 5 (strongly agree). Results: Of 47/50 (94%) respondents, self-efficacy significantly improved across all items (mean pre vs. post ratings, P <.001). Housestaff were more prepared to manage patients on chronic opioid medication (2.8 vs. 3.8), including those with substance use disorders (2.3 vs. 3.4). They felt more prepared to identify opioid dependence (2.8 vs. 3.9) and overall rated the curriculum favorably (4.2). Conclusions: The brief curriculum was well received and appears effective. Further study is needed to determine practice impact.

KEYWORDS:

• Chronic pain
• curriculum
• primary care
• opioid
• substance abuse

The Authors gratefully acknowledge the support of the Center for Substance Abuse Treatment (CSAT) of the Substance Abuse and Mental Health Administration (SAMHSA), Department of Health and Human Services (DHHS), including Robert Lubran, MS, MPA, Director Division of Pharmacologic Therapies, and Anton Bizzell, MD, Project Officer for the Prescription Drug Misuse and Abuse Program of during the study period. Dr. Gunderson and Dr. Levin are supported through the National Institute on Drug Abuse K23 DA 020000 and K02 DA 000465, respectively. The authors also thank Gydmer Perez for assistance with data entry, DB Consulting Group and Nicholas Fiebach, MD, for critical review of the manuscript. The authors thank the faculty members who reviewed the curriculum and housestaff participants.

The curriculum was delivered in a workshop at the 31st Annual National Conference of the Association for Medical Education and Research on Substance Abuse (AMERSA), Washington DC, November 2007, and data were presented at the 70th Annual Scientific Meeting for the College on Problems Drug Dependence (CPDD), San Juan, PR, June 2008.

Notes

∗Note: All links accessed March 2, 2009.