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Characteristics of physicians who prescribe opioids for chronic pain: a meta-narrative systematic review

Authors Hooten WM, Dvorkin J, Warner NS, Pearson ACS, Murad MH, Warner DO

Received 21 January 2019

Accepted for publication 25 June 2019

Published 24 July 2019 Volume 2019:12 Pages 2261—2289


Checked for plagiarism Yes

Review by Single anonymous peer review

Peer reviewer comments 2

Editor who approved publication: Dr Erica Wegrzyn

W Michael Hooten,1 Jodie Dvorkin,2 Nafisseh S Warner,1 Amy CS Pearson,3 M Hassan Murad,4 David O Warner1

1Department of Anesthesiology and Perioperative Medicine, Mayo Clinic College of Medicine, Rochester, MN, USA; 2Institute for Clinical Systems Improvement, Minneapolis, MN, USA; 3Department of Anesthesia, University of Iowa Carver College of Medicine, Iowa City, IA, USA; 4Department of Medicine, Mayo Clinic College of Medicine, Rochester, MN, USA

Background: The primary objective of this systematic review was to identify the characteristics of physicians who prescribe opioids to adults with chronic pain. This review was limited to studies examining fully-trained physicians, as relevant characteristics of resident physicians and non-physician clinicians may differ.
Methods: A comprehensive search of databases from January 1, 1980 to December 5, 2017 was conducted. Eligible study designs included (1) randomized trials; (2) nonrandomized prospective and retrospective studies; and (3) cross-sectional observational studies. The risk of bias in the included studies was assessed using an adapted version of the Newcastle-Ottawa Scale for cross-sectional studies. A total of 2508 records were screened and 22 studies met inclusion criteria. The majority of studies were cross-sectional (n=20) and the total number of participants was 8433.
Results: The risk of bias was high overall. The majority of physicians were confident managing and prescribing opioids for chronic pain but had high levels of dissatisfaction. Physicians reported high awareness of the potential for opioid misuse and were concerned about inadequate prior training in pain management. The majority of physicians were less likely to prescribe for patients with a history of substance abuse and reported major concerns about regulatory scrutiny.
Conclusion: This systematic review provides the foundation for the development of prospective studies aimed at further elucidating the constellation of mechanisms that influence physicians who manage pain and prescribe opioids.

Keywords: systematic review, opioid, prescription, physician characteristics

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