Primary Care Practitioners' Guidelines in the Treatment of Chronic Non Cancer Pain
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Nurse practitioners work in primary care more than any other specialty where they are faced with the difficult task of managing patients who present with chronic non-cancer pain (CNCP). Opioid medications are commonly prescribed in primary care for chronic pain however, the misuse, abuse and diversion of prescription opioids has led to an international opioid epidemic with more than 15,000 deaths due to unintentional overdose in 2015. (Centers for Disease Control & Prevention, 2016).
The purpose of this project was to enhance primary care nurse practitioners’ knowledge regarding opioid prescribing evidence-based guidelines in the treatment of CNCP. By enhancing prescribers’ knowledge of the guidelines, nurse practitioners may help to reduce the prevalence of opioid misuse and decrease the number of deaths due to opioid overdose.
Utilizing Malcolm S. Knowles Adult Learning Theory an educational lecture was created to increase nurse practitioners awareness of the opioid epidemic and provide knowledge regarding the Center for Disease Control and Prevention’s (CDC) recommended opioid prescribing guidelines for chronic pain in primary care. This two-hour lecture was disseminated at two MNA sponsored pharmacology lectures. A pre and post- test survey was given to determine nurse practitioners knowledge of the CDC’s opioid guidelines and evaluate the usefulness of the lecture.
Eighty-eight participants completed both the pre and post surveys questions. All respondents were nurse practitioners with 67 respondents working in primary care, four in internal medicine, ten in Emergency Room and seven in a specialty clinic or other. Seventy-nine respondents reported possessing a controlled substance prescriptive authority and of those, all 79 reported they currently prescribe controlled substances. Nine of the attendees responded they were not registered by the Drug Enforcement Agency (DEA) to prescribe controlled substances. On the pre survey knowledge questions 57% of respondents answered more than 50% of the questions incorrectly (7 out of 10). On the post survey questionnaire 100%, all 88 respondents answered all 12 questions correctly.
The surveys from the educational lecture revealed improved responses to questions related to recommended guidelines for chronic non cancer pain as evidenced by correct responses on the post lecture questionnaire as compared to the pre survey responses. Of the nurse practitioners surveyed, only two of the attendants reported having prior knowledge of the CDC guidelines for opioid prescribing leaving 77 of the nurse practitioners who possess controlled substance prescriptive authority reporting no prior knowledge of the recommended CDC guidelines. Further research is suggested to assess compliance with the guidelines after attending educational lectures.