Acute pain treatment by physicians and dentists: Results from a WREN/PEARL collaborative survey

1. Acute pain treatment by physicians and dentists: Results from a WREN/PEARL collaborative survey Mark Remiker, MA: Peggy O'Halloran, MPH: Michael Grasmick, PhD; Frederick Curro, MD; Paul Smith, MD Wisconsin Research and Education Network and the University of Wisconsin Department of Family Medicine

2. WREN Wisconsin Research and Education Network Founded in 1987 130 Clinics 20 Healthcare organizations 37 communities

3. PEARL • Practitioners Engaged in Applied Research and Learning • NIH-sponsored network of private-practice dentists • Launched in 2005 at NYU College of Dentistry • Over 200 Practitioner-Investigators in 32 states • 16 studies are ongoing or completed, with almost 6,000 subjects enrolled

4. Background & Significance Acute Pain: • common both in dentistry and primary care • very little literature on prevalence in primary care • physician attitudes poorly described in literature • no literature to support the anecdotal link of attitudes to prescriptions given and adequacy of pain relief

5. Collaborative Aim Describe the attitudes and practices related to the treatment of acute pain and any differences between primary care clinicians and dentists through electronic survey. - Descriptive analysis - Hypothesis generation

6. Survey Group Members Simple online registration Respond to at least 80% Responses inform WAFP board how you feel about the issue in question Surveys Address issues important to primary care 12 or less a year Take approximately 5 minutes

7. Methods: the sample Table 1: Sample demographics

8. Method: Survey 2 (general attitudes) - How often do you use the following treatment options for acute orofacial pain? Education Medication Referrals - Drugs commonly prescribed? NSAIDS Opioids Muscle relaxants - Attitudes toward prescribing opioids

9. Methods: Survey 1 (Scenarios) Scenario 1 (TRAUMA) A 25 year old male with no known medication allergies slipped on the ice while carrying a package and fell hitting his face on the curb about 12 hours ago. He did not lose consciousness, but he has facial bruises, swelling and broke off part of an incisor. He put the ice on the injury when he got home last night because of the pain. He took Ibuprofen 600mg every 6 hours and it “helps some,” but he woke up twice last night because of the pain. He has an angular fracture with no pulpal exposure and approximately 1/3 of the incisal edge is gone. You do not suspect any bone fractures. Scenario 1: TRAUMA Prescription: Ibuprofen 600 mg/6 hours Effective: SOME

10. Methods: Survey 1 (Scenarios) Scenario 2 (SINUSITUS) A 23 year old woman with no known medication allergies presents with right maxillary tooth pain, a two week history of gradual improving upper respiratory symptoms, but worsening facial pressure and pain for the past 10 days. She took some Claritin D 24 hours which did not help much. You make a clinical diagnosis of right maxillary sinusitis. Scenario 2: SINUSITUS Prescription: Ibuprofen 600 mg/6 hours Effective: NO

11. Methods: Survey 1 (Scenarios) Scenario 3 (ABSCESS) A 43 year old female with no known medication allergies has had a right lower mandibular pain intermittently for 2 weeks. She has developed swelling and increasing pain the last 3 days inadequately controlled with acetaminophen 500 mg every 4 hours. She woke up 4 times last night and is in obvious distress. You make a diagnosis of tooth abscess. Scenario 3: ABSCESS Prescription: acetaminophen 50 mg/4 hours Effective: NO

12. Methods: Survey 1 (Scenarios) Post-scenario questions Any non-medication treatments? Would you recommend a medication? Name Dose Instructions Prescription? Medication 2?

13. Preliminary Results Correlation Matrix * = p < 0.000

14. Preliminary Results Med Recommendation: Trauma Pearson Chi2 = 1.59 p = 0.21

15. Scenario 1: Trauma First Med Recommendation • Scenario 1: TRAUMA • Prescription: Ibuprofen 600 mg/6 hours • Effective: SOME

16. Preliminary Results Med Recommendation: Sinusitis Pearson chi2 = 25.78 p < 0.00

17. Scenario 2: Sinusitis First Med Recommendation • Scenario 2: SINUSITUS • Prescription: Ibuprofen 600 mg/6 hours • Effective: NO

18. Preliminary Results Med Recommendation: Abscess Pearson chi2 = 0.008 p = 0.93

19. Scenario 3: Abscess First Med Recommendation • Scenario 3: ABSCESS • Prescription: acetaminophen 50 mg/4 hours • Effective: NO

20. Preliminary Results Prescribing opioids across scenarios Pearson chi2 = 9.028 p = 0.003

21. Summary of preliminary findings Individuals who prescribe more for one ailment are likely to prescribe more for others. Dentists less likely than doctors to prescribe for sinus infection Dentists more likely than doctors to avoid prescribing opioids

22. Limitations - Sample size - Sex ratio - Exploratory analyses - Attitudes only, not behaviors - Analyses do not speak to a effectiveness

23. Future Directions 1. Analyze the rest of survey 1 and the entire 2nd survey 2. What methods are most effective? 3. What are the patients attitudes?

24. Thank you - Questions? Comments? Did anyone generate any Hypotheses? - WREN/PEARL survey takers - PEARL group: Van P. Thompson, Don Vena, Frederick Naftolin, Matthew Buchholz - WREN group: Hannah Louks - National Institute of Health