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5 Articles in this Series
A Worldwide Take on Opioid Prescribing and Access
Evolution of the Neuropathic State and Evidence-Based Treatment
Incidence and Causes of Persistent Chronic Pain After Major Surgeries
Notable Industry Surveys
Putting a Stop to Guideline Warfare: Lower Back Pain

Notable Industry Surveys

Among the poster sessions at the 2018 World Congress on Regional Anesthesia and Pain Medicine, sponsored by the American Society of Regional Anesthesia and Pain Medicine (ASRA) in New York City, three survey abstracts stood out for providing unique insights into the pain management community. These are summarized below.

Prevalence of Opioid-Induced Hyperalgesia

An international team of academic and practicing physicians presented on the “Clinical Implications of Opioid-Induced Hyperalgesia in Chronic Pain Patients.”1 Noting that the clinical utility of opioids “may be limited by an opposing effect that induces greater pain sensitivity and lower pain thresholds in patients,” the authors set out to review attitudes of chronic pain practitioners regarding this counteractive phenomenon known as opioid-induced hyperalgesia (OIH). They pointed out that there is a lack of standard guidelines for assessing and treating OIH, leading to uncertainties in the pain management community.

After surveying members of American Society of Regional Anesthesia and Pain Medicine and the Canadian Anesthesiologists’ Society (318 total respondents), the team reported that a majority of responding chronic pain practitioners (75.5%) said OIH is observed in their practice. Nearly 40% of responding practitioners stated that OIH occurs in more than 5% of their patients on long-term opioid therapy. Major indicators of OIH were perceived to include allodynia, diffuse pain, increasing pain scores, and increasing demand for breakthrough opioids.

Of interest, although insignificant, 3.1% of respondents reported that they did not believe OIH exists clinically, and 2.2% of respondents had not heard of OIH. The survey also uncovered considerable practice variation among the diagnosis and management of opioid-induced hyperalgesia.


How Can PCPs and Pain Specialists Communicate Better?

A study out of the Advocate Illinois Masonic Medical Center (AIMMC) reviewed practice patterns and attitudes among primary care physicians (PCPs) and pain specialists regarding opioid therapy in multidisciplinary chronic pain management.2 To set the stage, the authors cited that “most opioids are prescribed by non-pain specialist care providers who have reported inadequate training in the field.” Their goal was to analyze practice patterns of these providers as well as those who specialize in pain management and opioid therapy in order to find any gaps and limiting factors in efficient patient care, including referrals and communication between the two types of providers.

Eligible questionnaire takers were identified through the AIMMC-affiliated database and the 2017 ASRA attendee list. Nearly 70% of the responding pain specialists “believed patients’ chronic pain has not been managed optimally” by their PCPs and that PCPs are “the most responsible for the failure of tri-lateral opioid contract.” For those chronic non-cancer pain patients who were referred by PCPs, preliminary survey data revealed that 33% of responding pain specialists found detailed electronic referral from PCPs, indicating their concerns about patient’s pain management, to be the most helpful tool on continuing care. However, less than 35% of pain specialists said they felt comfortable taking over the care of patients who had already begun opioid therapy.

Among the PCPs taking the questionnaire, approximately 50% noted they did not have formal training in pain management and only 40% said they felt comfortable prescribing opioids for chronic non-cancer pain. Just over 50% reported that they do not use psychological assessments in patients presenting with chronic pain, nor does this percentage receive feedback from other practitioners such as physical therapists, pain specialists, and psychologists.

The authors concluded that “poor communication” was a contributing factor to non-optimal chronic non-cancer pain management and multidisciplinary care among both healthcare provider groups. It was clear from the survey results that pain specialists prefer to initiate opioid therapy rather than to receive a referred patient who has already begun such treatment; on the other hand, PCPs reported legitimate concerns about beginning such therapy and the time it takes to obtain a pain specialist’s opinion.


Despite Epidemic, Peer-Reviewed Opioid Publications at Status Quo

A third poster presented at the ASRA-hosted World Congress aimed to address whether opioid-related research has increased since the opioid epidemic. M. Denise Daley of the University of Texas Medical Branch reviewed relevant articles in three leading English-language pain medicine journals between the periods of 2007-2009 and 2015-2017.3

After identifying more than 3,150 relevant articles, she found that the percentage of opioid-related publications was generally similar in all years, with a slight increase in 2017 (9.45%). Of these, there were 85 (2.69%) published articles focusing on “prescribing/abuse/addiction” (2.69%). Daley concluded that there “has been no major increase in opioid-related research in recent years, despite the appearance of the opioid epidemic.” She pointed out that her analysis evaluated only those articles published in three select print journals (Clinical J Pain, J Pain, Pain), and that other publications may be in the works.



  1. Kum E, Busse JW, DeLeon-Casasola O, et al. Clinical Implications of Opioid-Induced Hyperalgesia in Chronic Pain Patients. Poster presented at the World Congress on Regional Anesthesia and Pain Medicine, April 19-21, New York City. 
  2. Mohammadi V, Knezevic NN, Candido KD. Practice Patterns And Attitude Of Primary Care Physicians And Pain Specialists Toward Opioids Therapy And Efficient Multidisciplinary Chronic Non-Cancer Pain Management. Poster presented at the World Congress on Regional Anesthesia and Pain Medicine, April 19-21, New York City. 
  3. Daley MD, Has Opioid-related Research Increased With the Opioid Epidemic? Poster presented at the World Congress on Regional Anesthesia and Pain Medicine, April 19-21, New York City. 
Next summary: Putting a Stop to Guideline Warfare: Lower Back Pain
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