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De-stress pain management: Assessing pain management care amongst primary care providers
Browder, B. H. [1]
Reynolds, C. [2]
Agnello, R. [3]

Journal: Postgraduate Medicine Date: 2025/12, 137(Sup2):Pages: 25–27. doi: Subito , type of study: mixed methods study


Keywords:

conference abstract [122]
continuing medical education [16]
family medicine [55]
knowledge [62]
mixed method study [105]
opioids [43]
osteopathic medicine [2064]
osteopathic physicians [206]
pain management [33]
programs [137]
USA [1717]

Abstract:

Background: The opioid epidemic continues to pose a significant public health challenge in the United States, with primary care providers playing a pivotal role in both the prevention and management of opioid use disorder (OUD). Osteopathic family physicians, particularly those practicing in underserved and rural areas, are often the first, and sometimes only, point of contact for patients experiencing chronic pain. Despite their critical role, many providers lack up-to-date knowledge and confidence in evidence-based pain management strategies, including opioid tapering, non-opioid alternatives, and non-pharmacological interventions such as osteopathic manipulative treatment (OMT). The COVID-19 pandemic further exacerbated these challenges, contributing to increased opioid misuse and overdose deaths, especially in vulnerable communities. In response, the American College of Osteopathic Family Physicians (ACOFP), in collaboration with the American College of Osteopathic Internists (ACOI), launched an educational initiative aligned with the FDA's Risk Evaluation and Mitigation Strategies (REMS) Blueprint. This initiative aimed to equip prescribers with the tools and knowledge necessary to manage pain safely and effectively, reduce reliance on opioids, and improve patient outcomes through a combination of online learning and interactive case-based discussions. Purpose/objectives: The «De-stress Pain Management: Rethinking Opioid and Non-Opioid Therapies» program was designed to address critical gaps in knowledge, confidence, and clinical practice among primary care providers managing patients with pain. The initiative aimed to improve understanding of opioid prescribing guidelines, enhance competence in individualized treatment planning, and promote the integration of non-opioid and non-pharmacological therapies, including OMT. By aligning with the FDA's REMS Blueprint, the program sought to ensure that participants could apply evidence-based strategies to reduce the risks associated with opioid use while maintaining effective pain control. The program also emphasized shared decision-making and patient-centered communication, particularly in the context of opioid tapering and treatment transitions. Ultimately, the goal was to encourage sustainable improvements in clinical behavior and patient safety across diverse healthcare settings. Methods: The program consisted of a 6.5 CME-credit online curriculum and five live case forums conducted throughout 2024. The target audience included osteopathic family and internal medicine physicians, as well as other primary care professionals such as physician associates, nurse practitioners, and pharmacists. Trainees including resident physicians, fellows, and medical students also completed the program. The curriculum was structured into modular, self-paced segments covering key topics from pain assessment to opioid use disorder management, supplemented by interactive case forums for real-world application. A mixed-methods evaluation approach was used. Quantitative data were collected through pre-and post-tests for each module, mid-course and end-of-curriculum surveys, and a 3-month follow-up survey. Statistical analyses included McNemar's test for knowledge retention and Fisher's Exact test for subgroup comparisons. Qualitative data was gathered from open-ended survey responses and case forum transcripts, to then be analyzed using inductive thematic analysis to identify practice changes and barriers. In total, 1,929 learners engaged with the curriculum, and 3,831 participated in case forums. Of these, 973 completed the curriculum and 2,240 completed the forums. The evaluation focused on knowledge gains, confidence improvements, anticipated and sustained practice changes, and subgroup differences by profession and experience level. Results: The «De-stress Pain Management» program demonstrated substantial educational impact, with measurable improvements both immediately after participation and at a 3-month follow-up. Immediate Post-Education Outcomes: Participants showed significant gains in knowledge and confidence across all REMS Blueprint domains. Specifically, 49% of learners improved their ability to individualize analgesic treatment, and 35% demonstrated better understanding of buprenorphine use for pain management. Confidence also increased, with 57% of module completers reporting they felt «very comfortable» managing patients in pain, and 65% expressing confidence in recognizing opioid use disorder (OUD). These gains were particularly strong among osteopathic physicians, though non-physician providers reported lower confidence levels. Over 80% of participants identified at least one intended practice change.common commitments included better pain assessment, more individualized treatment planning, and increased use of non-pharmacological therapies such as OMT. 3-Month Follow-Up Outcomes: Sustained knowledge retention was high. Among follow-up respondents, 82% retained knowledge on individualized analgesic treatment, and 91% retained knowledge on the appropriate use of buprenorphine. At follow-up, 86% of respondents reported either maintaining or progressing toward implementing changes in their clinical practice. More than 60% had begun adjusting how they communicate with patients about pain and opioid tapering. Reported changes included increased use of buprenorphine, greater integration of non-pharmacological therapies, and improved patient communication. Barriers to change included patient resistance to modifying opioid-based treatments (34%), stigma associated with buprenorphine, insurance limitations, and time constraints. Subgroup analysis revealed that family medicine physicians showed the highest level of engagement and knowledge retention. On the other hand, non-physician providers continued to report lower confidence, particularly in managing OUD. These results underscore the program's effectiveness in promoting both immediate and sustained improvements in knowledge, confidence, and clinical behavior related to pain management. Conclusions: The «De-stress Pain Management» program effectively improved knowledge, confidence, and clinical practices among primary care providers in opioid prescribing, tapering, and non-pharmacological pain management. The combination of self-paced modules and live case forums aligned with the FDA's REMS Blueprint proved impactful, particularly in enhancing individualized treatment planning and the appropriate use of buprenorphine. Despite these gains, challenges remain. Patient resistance to treatment changes, systemic barriers, and provider discomfort with certain therapies, especially among non-physician clinicians, highlight areas for continued support. Future research should examine the long-term effects of such education on prescribing behaviors and patient outcomes, including pain control and opioid use disorder rates. Further studies should also explore how provider characteristics (e.g., specialty, experience, practice setting) influence educational impact. Enhancing future programs with real-world simulations, peer mentoring, and patient-centered outcome tracking could strengthen knowledge application and sustainability. Integrating patient perspectives will also be critical to refining educational strategies and ensuring they translate into meaningful improvements in care.

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