Training internal medicine residents to manage chronic pain and prescription opioid misuse

Background: Residents feel unprepared to care for patients with chronic pain on long-term opioids who exhibit signs of prescription opioid misuse. Objective: Describe an educational intervention for internal medicine residents to improve confidence, practices, attitudes, and self-reported knowledge of resources for chronic pain and opioid misuse. Methods: The intervention included 2 sessions. Session 1 (3hours): a lecture on chronic pain, prescription opioid misuse, and opioid use disorders and communication skills practice. The residents were asked to use one of these skills during the following week. Session 2 (1.5hours): debriefing of patient encounters and overview of: prescription opioid monitoring strategies, discontinuation of prescription opioids when appropriate, and treatment for opioid use disorders. Pre- and post-assessments evaluated change in residents' safe opioid prescribing confidence, self-reported practices, attitudes, and self-reported knowledge of available patient resources. Results: Ninety-one residents completed the intervention, with 44 and 43 completing the pre- and post-assessments, respectively. Utilizing a 4-point Likert scale (1 = strongly disagree, 2 = disagree, 3 = agree 4 = strongly agree), residents reported improved confidence in skills managing patients with chronic pain (3.0vs. 2.4, P < .0001), skills identifying which patients with chronic pain have developed an opioid use disorder (3.0vs. 2.4, P < .0001), and understanding how to monitor for benefit versus harm (3.0vs. 2.5, P < .0005). They also noted improved ability identifying resources for patients with chronic pain and opioid use disorders. There was a nonsignificant improvement in resident reported comfort talking to patients about the need to discontinue opioids. Residents did not report an increase in use of safe opioid prescribing monitoring strategies or feelings of support in their prescribing decisions by preceptors. Conclusions: A brief training can improve residents' self-reported knowledge and confidence in managing patients with chronic pain and safe opioid prescribing practices. How this change in confidence affects patient care requires further study.