• 1. 

    Brady KT, McCauley JL & Back SE: Prescription opioid misuse, abuse, and treatment in the United States: an update. Am J Psychiatry 173 : 18, 2016.

  • 2. 

    Antman KH, Berman HA & Flotte TR et al.: Developing core competencies for the prevention and management of prescription drug misuse: a medical education collaboration in Massachusetts. Acad Med 91 : 1348, 2016.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 3. 

    Manchikanti L & Singh A: Therapeutic opioids: a ten-year perspective on the complexities and complications of the escalating use, abuse, and nonmedical use of opioids. Pain Physician 11 (suppl) : S63, 2008.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 4. 

    McHugh RK, Nielsen S & Weiss RD: Prescription drug abuse: from epidemiology to public policy. J Subst Abuse Treat 48 : 1, 2015.

  • 5. 

    Poon SJ, Nelson LS & Hoppe JA et al.: Consensus-based recommendations for an emergency medicine pain management curriculum. J Emerg Med 51 : 147, 2016.

  • 6. 

    Rudd RA, Seth P & David F et al.: Increases in drug and opioid-involved overdose deaths— United States, 2010–2015. MMWR Morbid Mortal Wkly Rep 65 : 1445, 2016.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 7. 

    Shah A, Hayes CJ & Martin BC: Characteristics of initial prescription episodes and likelihood of long-term opioid use—United States, 2006–2015. MMWR Morbid Mortal Wkly Rep 66 : 265, 2017.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 8. 

    Edlund MJ, Martin BC & Russo JE et al.: The role of opioid prescription in incident opioid abuse and dependence among individuals with chronic noncancer pain: the role of opioid prescription. Clin J Pain 30 : 557, 2014.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 9. 

    Wang J, Liu GT & Mayo HG et al.: Pain management for elective foot and ankle aurgery: a systematic review of randomized controlled trials. J Foot Ankle Surg 54 : 625, 2015.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 10. 

    Bobbitt KL, Keplinger LM & Althari HK: Understanding addiction: the orthopedic surgical perspective to a significant problem. Clin Podiatr Med Surg 25 : 493, 2008.

  • 11. 

    Meyr AJ & Steinberg JS: Legal aspects of podiatric pain management. JAPMA 100 : 511, 2010.

  • 12. 

    Smith RG: A review of opioid analgesics frequently prescribed by podiatric physicians. JAPMA 96 : 367, 2006.

  • 13. 

    Chou R, Gordon DB & de Leon-Casasola OA et al.: Management of postoperative pain: a clinical practice guideline from the American Pain Society, the American Society of Regional Anesthesia and Pain Medicine, and the American Society of Anesthesiologists' Committee on Regional Anesthesia, Executive Committee, and Administrative Council. J Pain 17 : 131, 2016.

    • Search Google Scholar
    • Export Citation
  • 14. 

    American Society of Anesthesiologists Task Force on Acute Pain Management: Practice guidelines for acute pain management in the perioperative setting: an updated report by the American Society of Anesthesiologists Task Force on Acute Pain Management. Anesthesiology 116 : 248, 2012.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 15. 

    Morris BJ & Mir HR: The opioid epidemic: impact on orthopaedic surgery. J Am Acad Orthop Surg 23 : 267, 2015.

  • 16. 

    Schwartz RH, Johnson NP & Hornung CA et al.: Awareness of substance abuse in orthopedic patients: a survey of orthopedic surgeons. South Med J 84 : 1455, 1991.

  • 17. 

    Touchet BK, Yates WR & Coon KA: Opioid contract use is associated with physician training level and practice specialty. J Opioid Manag 1 : 195, 2005.

  • 18. 

    Teichman PG: A tool for safely treating chronic pain. Fam Pract Manag 8 : 47, 2001.

  • 19. 

    Cummins D, Frank T & Dickson S et al.: Assessment of hydrocodone prescribing within a family medicine residency program. J Ark Med Soc 111 : 182, 2015.

    • Search Google Scholar
    • Export Citation
  • 20. 

    Adams NJ, Plane MB & Fleming MF et al.: Opioids and the treatment of chronic pain in a primary care sample. J Pain Symptom Manage 22 : 791, 2001.

  • 21. 

    Rudder M, Tsao L & Jack HE: Shared responsibility: Massachusetts legislators, physicians, and an act relative to substance use treatment, education, and prevention. AMA J Ethics 18 : 950, 2016.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 22. 

    Poon SJ & Greenwood-Ericksen MB: The opioid prescription epidemic and the role of emergency medicine. Ann Emerg Med 64 : 490, 2014.

  • 23. 

    Poon SJ, Greenwood-Ericksen MB & Gish RE et al.: Usability of the Massachusetts prescription drug monitoring program in the emergency department: a mixed-methods study. Acad Emerg Med 23 : 406, 2016.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 24. 

    Choo EK, Mazer-Amirshahi M & Juurlink D et al.: The prescription opioid epidemic: social media responses to the residents' perspective article. Acad Emerg Med 67 : 40, 2016.

    • Search Google Scholar
    • Export Citation
  • 25. 

    Davis CS & Carr D: Physician continuing education to reduce opioid misuse, abuse, and overdose: many opportunities, few requirements. Drug Alcohol Depend 163 : 100, 2016.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 26. 

    Fox AD, Kunins HV & Starrels JL: Which skills are associated with residents' sense of preparedness to manage chronic pain? J Opioid Manag 8 : 328, 2012.

  • 27. 

    Yanni LM, McKinney-Ketchum JL & Harrington SB et al.: Preparation, confidence, and attitudes about chronic noncancer pain in graduate medical education. J Grad Med Educ 2 : 260, 2010.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 28. 

    Saroyan JM, Schechter WS & Tresgallo ME et al.: Assessing resident knowledge of acute pain management in hospitalized children: a pilot study. J Pain Symptom Manage 36 : 628, 2008.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 29. 

    Council on Podiatric Medical Education: Standards and requirements for approval of podiatric medicine and surgery residencies. Available at: https://www.cpme.org/files/CPME/CPME%20320%20Updated%20May%202020.pdf. Accessed February 2, 2017.

    • Search Google Scholar
    • Export Citation
  • 30. 

    Saroyan JM, Schechter WS & Tresgallo ME et al.: Balancing knowledge among resident specialties: lecture-based training and the OUCH card to treat children's pain. J Grad Med Educ 2 : 73, 2010.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 31. 

    Rickert J, Devlin K & Krohn K: Comprehensive care of pain: developing systems and tools to improve patient care and resident education. Int J Psychiatry Med 51 : 337, 2016.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 32. 

    Colburn JL, Jasinski DR & Rastegar DA: Long-term opioid therapy, aberrant behaviors, and substance misuse: comparison of patients treated by resident and attending physicians in a general medical clinic. J Opioid Manag 8 : 153, 2012.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 33. 

    Oya H, Matoba M & Murakami S et al.: Mandatory palliative care education for surgical residents: initial focus on teaching pain management. Jpn J Clin Oncol 43 : 170, 2013.

  • 34. 

    Holten KB & Veasey GD Sr: Managing chronic pain: what's the best approach? J Fam Pract 57 : 806, 2008.

  • 35. 

    Gordon AJ & Saba SK: Confronting the opioid epidemic through publication, promotion, and dissemination of evidence-based addiction scholarship. Subst Abuse 37 : 379, 2016.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 36. 

    Hero JO, McMurtry C & Benson J et al.: Discussing opioid risks with patients to reduce misuse and abuse: evidence from 2 surveys. Ann Family Med 14 : 575, 2016.

  • 37. 

    Dowell D, Haegerich TM, Chou R: CDC guideline for prescribing opioids for chronic pain–United States, 2016. JAMA 315 : 1624, 2016.

  • 38. 

    Hadden KB, Prince LY & Barnes CL: Health literacy and opioid use in orthopaedic patients. J Surg Orthop Adv 25 : 234, 2016.

Attitudes and Knowledge Regarding Pain Management and Addiction in Massachusetts: A Mixed Methods Study on Podiatric Residents

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Background

The opioid epidemic has hit disastrous levels across the United States. Many attempts have been made to counteract this, including policy changes and modification of provider and patient behavior. The purpose of this study was to understand the current state of podiatric residents' knowledge regarding pain management and addiction.

Methods

This study used mixed quantitative-qualitative methods. Two focus groups were conducted with two podiatric residency programs to understand current issues and inform the creation of a survey. A 30-question survey was created and peer reviewed to assess general pain management knowledge, levels of confidence in pain management and addiction, and areas for improvement.

Results

Pain management education in podiatry is mainly focused on opioids. These concepts are often taught in a nonstandardized method, which does not often include nonopioid alternatives. Knowledge of risk factors for addiction was lacking, whereas knowledge of behaviors concerning for addiction was more bountiful. Thirty-three surveys were completed of a possible 39. A knowledge score was created from eight survey questions for a total of 10 points, with an average score of 4.61. There was no statistical difference between those with and without a pain management rotation. Nearly all residents felt comfortable managing surgical pain. The residents are “never” or “only occasionally” inquiring about risk factors for addiction. Questions asked also suggest that the residents are not thinking about their role within the opioid epidemic.

Conclusions

As the opioid epidemic grows, it is imperative to examine the causes and solutions to the problem. Focusing efforts on educating resident physicians is one method to address the issue. The results of this study show that pain management basics need to be reinforced and more time must be spent emphasizing the importance of thorough patient histories and educating patients when prescribing pain medication.

Northwood Foot and Ankle Center, Holland, MI. Dr. Sundling is now with Foot and Ankle Specialists of West Michigan, Grand Rapids, MI.

Corresponding author: Rebecca A. Sundling, DPM, MPH, Foot and Ankle Specialists of West Michigan, 2144 East Paris Avenue SE, Ste 100, Grand Rapids, MI 49546. (E-mail: rasundling@gmail.com)