Referring patients with chronic noncancer pain to pain clinics: survey of Ontario family physicians.

OBJECTIVE To examine the factors associated with FPs' referrals of patients with chronic noncancer pain to a tertiary care pain clinic. DESIGN A questionnaire-based survey; data were analyzed using univariate methods. SETTING A tertiary care pain clinic in Toronto, Ont. Participants All FPs who referred patients to the clinic between 2002 and 2005. MAIN OUTCOME MEASURES Variables explored included FPs' sex, age, and ethnic background, ethnicity of patient groups seen, and FPs' rationale or barriers influencing referrals to specialized pain clinics. RESULTS The response rate was 32% (47 of 148 FPs). There were no statistically significant differences between respondents and non-respondents in sex, age, duration of practice, and university of graduation, or between the variables of interest and the referral patterns of those who did respond. The mean age of respondents was 50 years; 47% of the FPs identified themselves as Canadian; and one-third of the respondents indicated that they referred more than 30 patients to pain clinics each year. The 3 most frequently cited reasons prompting referral to pain clinics were requests for nerve blocks or other injections, desire for the expertise of the program, and concerns about opioids; the 3 most prevalent barriers were long waiting lists, patient preference for other treatments, and distance from the clinic. CONCLUSION Although the results of our survey of FPs identify certain barriers to and reasons for referring patients to pain clinics, the results cannot be generalized owing to the small sample of FPs in our study. Larger studies of randomly selected FPs, who might or might not refer patients to pain clinics, are needed to provide a better understanding of chronic noncancer pain management needs at the primary care level.