By Pat Anson, Editor

Many pain patients report having trouble getting opioid pain medication prescribed by their physicians. So they may be surprised to hear about a new survey that found many doctors believe the overprescribing of antibiotics is a far bigger problem than opioids.

The random survey of over 1,100 members by the American College of Physicians (ACP) – most of them doctors who specialize in internal medicine -- asked them to identify two treatments frequently used by internists that are unlikely to provide “high value care” to patients.

The number one problem – identified by over 27% of the doctors -- was antibiotic prescribing, mostly for treating upper respiratory infections.

The second biggest problem was aggressive life support treatment for terminally ill patients (8.6%), followed by opioid medication for chronic pain management.

Only 7.3% of the doctors felt opioids do not provide high value care.

Dietary supplements (4.9%); statins (4.8%); proton-pump inhibitors (4.5%); cardiac procedures such as angioplasty, stents and catheters (3.5%); and antidepressants and sleep aids (3.4%) were also identified as treatments that often do not provide value.

"While many current clinical guidelines recommend appropriate care, the results of this survey may reflect intrinsic motivations to err on the side of treatment rather than 'doing nothing,'" said lead author Amir Qaseem, MD, Vice President of Clinical Policy at ACP. "However, as health care shifts to a value driven system, this study shows that doctors are willing to critically assess their own clinical practice."

Interestingly, non-pharmacological pain management -- mostly related to back pain -- was mentioned by 1.8% of the doctors as a treatment that provides little value. The Centers for Disease Control and Prevention recommends non-pharmacological treatment, such as physical therapy and cognitive behavioral therapy, as an alternative to opioids.

The study findings are being published in the Annals of Internal Medicine.

The ACP maintains a list of "high value care" recommendations to help doctors and patients better understand the benefits, harms, and costs of healthcare. Some expensive tests and treatments have high value, according to the ACP, because they provide high benefit and low harm. Conversely, some inexpensive tests or treatments have low value because they do not provide enough benefit and might even be harmful.

The ACP is the largest medical specialty organization in the United States. ACP members include 148,000 internal medicine physicians (internists), related subspecialists and medical students.