Harsha Shanthanna1,2,3, Anuj Bhatia4,5,6, Mohan Radhakrishna7, Emilie Belley-Cote8,9, Thuva Vanniyasingam10, Lehana Thabane8,11, Jason W Busse10,8. 1. The Department of Anesthesia, McMaster University, Hamilton, ON, Canada. shanthh@mcmaster.ca. 2. The Research Institute of St Joseph's Hospital, Hamilton, ON, Canada. shanthh@mcmaster.ca. 3. Department of Anesthesia, Michael G. DeGroote School of Medicine, McMaster University, HSC-2V9, 1280 Main St. West, Hamilton, ON, L8S 4K1, Canada. shanthh@mcmaster.ca. 4. Department of Anesthesia and Pain Medicine, Toronto Western Hospital, Toronto, ON, Canada. 5. Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, ON, Canada. 6. The Department of Anesthesia and Pain Management, University of Toronto, Toronto, ON, Canada. 7. The Department of Physical Medicine and Rehabilitation, McGill University, Montreal, QC, Canada. 8. Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada. 9. Population Health Research Institute, McMaster University, Hamilton, ON, Canada. 10. The Department of Anesthesia, McMaster University, Hamilton, ON, Canada. 11. The Research Institute of St Joseph's Hospital, Hamilton, ON, Canada.
Abstract
PURPOSE: The use of interventional pain management (IPM) modalities to alleviate chronic pain is increasing despite the lack of high-quality evidence. We undertook this survey to explore patterns, training, and attributes of IPM practice. METHODS: We administered a 32-item survey via seven Canadian physician member organizations, whose members were engaged in the management of chronic pain. RESULTS: Of 777 physicians contacted, 256 (33%) responded: 45 (6%) declined to participate and 211 (27%) agreed to participate; the number of participants answering any given question varied. One hundred and sixty-nine of 194 (87%) practiced IPM and 103 of 194 (53%) managed only non-cancer pain. Pain management training of ≥ six months was associated with higher odds of IPM training (odds ratio [OR], 2.98; 95% confidence interval [CI], 1.32 to 6.7), but not necessarily ongoing IPM practice (OR, 1.97; 95% CI, 0.74 to 5.3). A substantial percentage of physicians (108 of 168 [64%]) practiced IPM based only on training received during either their base residency program or courses. Only 48 of 186 (26%) felt that there were adequate opportunities for IPM training, and 69 of 186 (37%) believed that their colleagues practiced IPM in accordance with the best current evidence. CONCLUSIONS: Our survey indicates that IPM practice and training were not uniform, and that interventional therapies for chronic pain may not be performed in accordance with the best available evidence. Our survey highlights a lack of IPM training opportunities, which may result in substandard training. Concerted efforts involving physician organizations and regulators are needed to standardize IPM training and develop clinical guidelines to optimize evidence-based practice.
PURPOSE: The use of interventional pain management (IPM) modalities to alleviate chronic pain is increasing despite the lack of high-quality evidence. We undertook this survey to explore patterns, training, and attributes of IPM practice. METHODS: We administered a 32-item survey via seven Canadian physician member organizations, whose members were engaged in the management of chronic pain. RESULTS: Of 777 physicians contacted, 256 (33%) responded: 45 (6%) declined to participate and 211 (27%) agreed to participate; the number of participants answering any given question varied. One hundred and sixty-nine of 194 (87%) practiced IPM and 103 of 194 (53%) managed only non-cancer pain. Pain management training of ≥ six months was associated with higher odds of IPM training (odds ratio [OR], 2.98; 95% confidence interval [CI], 1.32 to 6.7), but not necessarily ongoing IPM practice (OR, 1.97; 95% CI, 0.74 to 5.3). A substantial percentage of physicians (108 of 168 [64%]) practiced IPM based only on training received during either their base residency program or courses. Only 48 of 186 (26%) felt that there were adequate opportunities for IPM training, and 69 of 186 (37%) believed that their colleagues practiced IPM in accordance with the best current evidence. CONCLUSIONS: Our survey indicates that IPM practice and training were not uniform, and that interventional therapies for chronic pain may not be performed in accordance with the best available evidence. Our survey highlights a lack of IPM training opportunities, which may result in substandard training. Concerted efforts involving physician organizations and regulators are needed to standardize IPM training and develop clinical guidelines to optimize evidence-based practice.
Authors: Xiaoqin Wang; Grace Martin; Behnam Sadeghirad; Andrea J Darzi; Rachel J Couban; Ivan D Florez; Holly N Crandon; Elena Kum; Yaping Chang; Meisam Abdar Esfahani; Laxsanaa Sivananthan; Fatemeh Mehrabi; Neil K Sengupta; Preksha Rathod; Rami Z Morsi; D Norman Buckley; Gordon H Guyatt; Y Raja Rampersaud; Christopher J Standaert; Thomas Agoritsas; Jason W Busse Journal: BMJ Open Date: 2021-07-09 Impact factor: 2.692