1 in 5 U.S. adults have chronic pain

81% of doctors are hesitant to take pain patients

Doctors weren't taught best practices for pain

If you've been prescribed pain pills and think doctors are avoiding you as a new patient, you just might be right.

A large percentage of primary-care doctors (81%) say they're hesitant to accept new patients who've been prescribed pain meds, a newly released survey shows. Even more (83%) say the opioid crisis makes it harder to treat pain patients.

The doctors' responses are part of the evolution of the nationwide opioid epidemic. Pain doctors and addiction specialists hope that primary-care physicians will begin to change their ways – and do so quickly. The reason? About 1 in 5 American adults, or about 50 million people, experience chronic pain and may need a doctor's help.

The new report, Drug Misuse in America 2019: Physicians Perspectives and Diagnostics Insights on the Evolving Drug Crisis, shows findings indicating that the opioid crisis continues to have a major impact on physicians and people in pain.

“I know someone who was ‘discharged’ from their provider because they are on opioids for chronic pain and their doctor didn’t want to continue treatment," said Emily Feinstein, executive vice president and CEO at Center on Addiction in New York City, a science-based, nonpartisan nonprofit that researches and promotes policy to end the U.S. addiction crisis. "And that person is having a hard time finding a new doctor."

That's dangerous, Feinstein said. Pain patients need to see qualified physicians, and if they're avoided, some may seek opioids on the black market, which can be tainted with highly potent fentanyl, she said. The powerful synthetic opiate has been disguised in pressed pills and sold as other, commonly prescribed opioids such as Vicodin and Percocet. It's blamed as a major killer in the opioid epidemic.

Related:List of the FDA-approved medications for opioid addiction

The new report includes findings from an online Harris Poll survey of 500 U.S. primary-care doctors and an analysis of more than 4.4 million tests from patients across the United States. The survey was commissioned by Quest Diagnostics and the Center on Addiction. Quest performed the drug-testing analysis.

The doctors' discomfort is familiar to Cincinnati area physicians.

"Providers are very well aware of the concerns of over-prescribing and the concerns of the opioid epidemic," said Dr. Erin Fries, chief clinical officer of Mercy Health-Cincinnati. "They also want to help their patients." But guidelines about prescribing pain pills might prevent doctors from giving these patients what they want.

That, she said, is why some doctors won't take on new patients who have pain.

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Part of the problem is that many patients and some unschooled doctors have inaccurate perceptions of what good treatment really is, said Dr. Mark Snyder, an orthopedic surgeon with TriHealth. Some primary care physicians, said Snyder, don't even tell someone to use a cane to help diminish knee-joint pain.

"Patients need to know that the pain that they have is far better treated if narcotics are limited and other things are used to control it," Snyder said. "There are safer, better solutions that should be used."

Philip Hartman, a family doctor with St. Elizabeth Physicians, agreed. He uses acupuncture for some patients. He also works part-time as an addiction doctor, prescribing non-narcotic medication, naltrexone, to people with opioid use disorder.

The heightened prescribing of painkillers began to take off in the 1990s, but the opioid crisis revved into high gear after pain was made the "fifth vital sign" in 2000. Opioid makers have been accused of marketing schemes that convinced doctors that patients were at low risk of addiction if they used certain prescribed opioids. And doctors have been accused of over-prescribing the medications to appease patients who became dependent on them.

"A lot of us have been burned in the past," Hartman said, noting that patients whose doctors want to taper their opioid use may give their physicians low satisfaction scores.

On the other hand, Hartman remembers, as recently as 2010, being taught in med school that increasing dosages for people who felt their opioids weren't working was always appropriate.

"We were literally taught that people don't get addicted if they take (pain pills) as prescribed by their physician," Hartman said.

The survey also shows that most physicians trust that their patients aren't misusing prescription pills, but Quest Diagnostics testing results show that about half are. That's mostly due to mixing medications, or taking two different classes of drugs that are safest when not used together.

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The Greater Cincinnati doctors say it may take a while, but the issues are likely to be resolved with more education among primary-care physicians, and a greater understanding among people who have chronic pain.

The doctors know they need more education, the study shows, and they haven't gotten it in med school.

"I think the education is the biggest problem," said Dr. Harsh Sachdeva, who practices at UC Health West Chester and is the director of the pain fellowship program at UC College of Medicine.

He said primary care doctors are at the "front lines." They see the patients first, and they need to know how to address their pain, how to assess addiction risk and when to recommend pain-management specialists.

Primary care doctors "need to treat pain appropriately," Sachdeva said.

Snyder said the research is available, and primary care physicians, who need continuing education credits, just have to learn it.

Hartman agrees. He has another expectation of his primary-care colleagues that he thinks will help prevent more pain as well as misuse of prescribed opioids:

"What I hope is that more physicians become educated on alternatives to treating pain."