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Primary Care MDs Decline Training In Pain Management

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Primary Care MDs Decline Training In Pain Management

The Chiro.Org Blog

The following survey reveals a depressing new trend in medicine. Although primary care physicians (PCPs) see the largest percentage of chronic pain patients (52%), they are also the least likely to feel confident in their ability to manage musculoskeletal and neuropathic pain conditions, and are least likely to favor mandatory pain education for all PCPs.

How bizarre is that?

Here’s the abstract for your review:

Pain Management by Primary Care Physicians, Pain Physicians, Chiropractors, and Acupuncturists: A National Survey

South Med J. 2010 (Aug); 103 (8): 738-747

Department of Pain Medicine and Palliative Care, Beth Israel Medical Center, New York, NY 10003, USA.

OBJECTIVES: Chronic pain is a serious public health problem and is treated by diverse health care providers. In order to enhance policies and programs to improve pain care, we collected information about the distribution of pain patients among four major groups of pain management providers: primary care physicians (PCPs), pain physicians, chiropractors, and acupuncturists, and the variation in the attitudes and practices of these providers with respect to some common strategies used for pain.

METHODS: National mail survey of PCPs, pain physicians, chiropractors, and acupuncturists (ntotal = 3,000).

RESULTS: Eight hundred seventeen responses were usable (response rate, 29%). Analyses weighted to obtain nationally representative data showed that:

PCPs treat approximately 52% of chronic pain patients,

pain physicians treat 2%,

chiropractors treat 40%, and

acupuncturists treat 7%.

Of the chronic pain patients seen for evaluation, the percentages subsequently treated on an ongoing basis range from 51% (PCPs) to 63% (pain physicians). Pain physicians prescribe long-acting opioids such as methadone, antidepressants or anti-convulsants, and other nontraditional analgesics approximately 50-100% more often than PCPs. Twenty-nine percent of PCPs and 16% of pain physicians reported prescribing opioids less often than they deem appropriate because of regulatory oversight concerns.

Of the four groups, PCPs are least likely to feel confident in their ability to manage musculoskeletal and neuropathic pain, and are least likely to favor mandatory pain education for all PCPs.

CONCLUSIONS: There is substantial variation in attitudes and practices of the various disciplines that treat chronic pain. This information may be useful in interpreting differences in patient access to pain care, planning studies to clarify patient outcomes in relation to different providers and treatment strategies, and designing a system that matches chronic pain patients to appropriate practitioners and treatments.

About the Author:

I was introduced to Chiro.Org in early 1996, where my friend Joe Garolis helped me learn HTML, the "mark-up language" for websites. We have been fortunate that journals like JMPT have given us permission to reproduce some early important articles in Full-Text format. Maintaining the Org website has been, and remains, my favorite hobby.


  1. jkmiller January 23, 2011 at 5:21 pm

    And this is why DC’s need to “get over” the past….. including the stubborn support of all things B.J. Palmer (this does not mean to ignore his contribution, but it IS 2011 and physical medicine has come a long way)….. and bone up on non-surgical orthopedics, including diagnostics and therapies. The lack of interest in pain management by primary MD’s leaves a HUGE patient population unsupported. If we do not fill the gap, we leave an argument for direct access by PTs. All that is holding them at bay right now it the AMA’s resistance at giving them rights to diagnose, and that is primarily by the orthopods. If they ever get direct access, Chiropractic will start to slowly die. It is time to put resources into research and secondary education in this area so that we can both aid a needy public and garner more than 13% of the patient population.

  2. karl January 23, 2011 at 11:49 pm

    I somewhat agree with jkmiller….”get over” the past. The chiropractic profession needs to continue/further evolve. We need to fill some of the gaps in chronic pain as well as wellness. Physical Therapy is making their move to further themselves among the physical medicine team………we’ve all watch this happen over the last 10-15 yrs. Many family practice physicians have neither the time and/or training to properly exam/treat NMS conditions.

  3. Sonya September 2, 2011 at 3:48 am

    If they ever get direct access, Chiropractic will start to slowly die.

  4. Frank M. Painter, D.C. September 2, 2011 at 10:30 am

    Hi Sonya

    People have been predicting the demise of chiropractic almost since it’s inception. We are tough, we are hardy, and we will continue to help sick people get well without the risks associated with drugs or surgery.

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