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What are Future Pain Physicians Learning? A Survey of Opioid Prescribing Practices Among US Pain Fellowship Programs.

BACKGROUND
Pain physicians have long been seen as subspecialists that commonly prescribe opioid medications, but the reality exists that primary care, oncologists, and surgical subspecialists find themselves embroiled in these clinical decisions just as frequently. It is a reasonable hope that pain physicians emerge as leaders in navigating these muddy waters, and the most important time to engrave practice standards is during clinical training.


OBJECTIVES
It was our hope to survey Accreditation Council for Graduate Medical Education (ACGME) pain fellowship programs throughout the United States in regard to practice behaviors for opioid prescribing in chronic noncancer pain (CNCP), and to assess what future pain physicians are learning during their training.


STUDY DESIGN
We developed a succinct, 8-question survey that attempted to gauge several aspects of opioid prescribing practices for CNCP. A survey was prepared in electronic format and e-mailed to each program director or chair of every ACGME accredited pain program in the United States.


METHODS
Our results were anonymously collected and percentage of response to each question was presented in bar graph format. The survey was prepared and initially sent out in November 2017 and intermittently redistributed through April 2018.


RESULTS
Of the 117 surveys sent through Survey Monkey, 42 responses were returned and collected, 39 fully completed surveys, and 3 partial completions, an estimate of roughly one-third of US ACGME pain fellowship programs.


LIMITATIONS
Completion of our survey was voluntary, roughly 35% of ACGME programs submitted a response.


CONCLUSIONS
Data displayed in collected responses illustrate that although there is variance in opioid prescribing practices for CNCP, many programs are limiting what they use opioids for and have substantial nonopioid pharmacologic and or interventional aspects to their practice. Future pain physicians throughout the country are learning diverse methods of pain management, with opioids being only a part of their toolbox.


KEY WORDS
Opioids, ACGME, pain management fellowship, guidelines, teaching.