619: Knowledge and Perceptions of Chronic Pain and Opioid Prescribing in Physicians in Armenia

Topic: Education, Societal Impact, and Others
Subtopic: Methodology others

Background and Aims: Chronic pain remains a major public health concern and is frequently undertreated. Evidence indicates that 30–40% of patients with early-stage cancer and 70–80% with advanced disease experience inadequate pain control. Despite established clinical guidelines, barriers to effective pain management persist, including insufficient training, regulatory restrictions on opioid prescribing, and misconceptions regarding opioid use and addiction.
This cross-sectional survey aimed to evaluate knowledge, attitudes, and self-reported practices related to chronic pain management and opioid prescribing among primary care physicians in Armenia, and to identify demographic and systemic factors associated with suboptimal pain care.

Methods: A cross-sectional survey was conducted across 11 regions of Armenia between September 2021 and August 2023. A structured questionnaire administered in electronic and paper formats which contained eight domains, including demographics, daily practice, perceptions of pain, management approaches, knowledge sources, attitudes toward opioid prescribing, personal experience, and barriers.
The target group of the survey included 351 primary care physicians. 302 of them (86.0%) women, 49 (13.9 %) men, 120 were general physicians (34.1%), 4 surgeons (1.14%), 10 anesthesiologists (2.8 %), 10 neurologists (2.8%), 8 oncologists (2.27 %), 114 family physicians (32.4.0%), 2 pediatricians (0.57 %), 3 palliative care specialists (0.85 %), 9 other specialties (2.56%).

Results: A total of 351 primary care physicians from polyclinics across Armenia participated; 86 % were women. Most respondents were general physicians and family physicians (76.3 %). The majority (84.6 %) had ≥10 years of clinical experience, including 70 % with >21 years. Overall, 87.2% reported regularly managing patients with pain, with at least 11–20 chronic pain cases annually. 49% believed pain cannot be objectively assessed, whereas 51% considered assessment feasible. Although 87.2% agreed that inadequate pain relief constitutes patient suffering, 12.8% stated that pain management was not their responsibility.
Self-assessed knowledge was reported as “full” by 35% and “partial” by 65%/.

Conclusions: This study demonstrates a substantial gap in knowledge and competencies related to chronic pain management among primary care physicians. Systemic factors include insufficient structured education in pain management, limited availability of specialized training programs, scarcity of translated professional literature, and the legacy of educational models historically restrictive toward opioid prescribing.
Individual factors include limited access to contemporary scientific literature, inadequate awareness of chronic pain as a complex biopsychosocial condition, and persistent stigma surrounding opioid use.
Addressing these barriers requires integration of comprehensive pain education into undergraduate and postgraduate curricula and the development of structured national training initiatives.
.

References: Barth, K. S., Guille, C., McCauley, J., & Brady, K. T. (2017). Targeting practitioners: A review of guidelines, training, and policy in pain management. Drug and Alcohol Dependence, 173, S22–S30. https://doi.org/10.1016/J.DRUGALCDEP.2016.08.641

Bin rsheed, A., & Chenoweth, I. (2017). Barriers that practitioners face when initiating insulin therapy in general practice settings and how they can be overcome. World Journal of Diabetes, 8(1), 28. https://doi.org/10.4239/WJD.V8.I1.28

Bixler, F. R., Radomski, T. R., Zickmund, S. L., Roman, K. L. M., Hausmann, L. R. M., Thorpe, C. T., Hale, J. A., Sileanu, F. E., & Gellad, W. F. (2019). Primary care physicians’ perspectives on Veterans who obtain prescription opioids from multiple healthcare systems. Journal of Opioid Management, 15(3), 183–191. https://doi.org/10.5055/JOM.2019.0502

Campbell, C. M., & Edwards, R. R. (2012). Ethnic differences in pain and pain management. Pain Management, 2(3), 219–230. https://doi.org/10.2217/PMT.12.7

Cao, L., & Hull, S. Z. (2021). Effectiveness of Educating Health Care Professionals in Managing Chronic Pain Patients Through a Supervised Student Inter-professional Pain Clinic. Medical Science Educator, 31(2), 479–488. https://doi.org/10.1007/S40670-020-01189-4

Edrington, J., Sun, A., Wong, C., Dodd, M., Padilla, G., Paul, S., & Miaskowski, C. (2009). Barriers to Pain Management in a Community Sample of Chinese American Patients with Cancer. Journal of Pain and Symptom Management, 37(4), 665–675. https://doi.org/10.1016/J.JPAINSYMMAN.2008.04.014

Embry, J., Reis, M. D., Couchman, G., Ledbetter, T. G., & Zolfaghari, K. (2020). Quality improvement initiative for pain management practices in primary care. Baylor University Medical Center Proceedings, 33(4), 513–519. https://doi.org/10.1080/08998280.2020.1814181

Jouini, G., Choinière, M., Martin, E., Perreault, S., Berbiche, D., Lussier, D., Hudon, E., & Lalonde, L. (2014). Pharmacotherapeutic management of chronic noncancer pain in primary care: Lessons for pharmacists. Journal of Pain Research, 7, 163–173. https://doi.org/10.2147/JPR.S56884

Mcneil, M. J., Ehrlich, B., Yakimkova, T., Wang, | Huiqi, Mishkova, V., Bezler, Z., Kumirova, E., Madni, A., Movsisyan, N., Williams, K., Baizakova, B., Chatman, G., Erimbetova, I., Ximena, |, Quintero, G., Golban, R., Kirby, | Brandi, Nunez, P., Ranadive, R., … Agulnik Are Co-Senior, A. (2022). Regional adaptation of the education in palliative and end-of-life Care Pediatrics (EPEC-Pediatrics) curriculum in Eurasia. Cancer Medicine, 00, 1–13. https://doi.org/10.1002/cam4.5213

Mikelyte, R., Abrahamson, V., Hill, E., & Wilson, P. M. (2020). Factors influencing trends in opioid prescribing for older people: A scoping review. Primary Health Care Research and Development. https://doi.org/10.1017/S1463423620000365

Nyirigira, G., Wilson, R. A., VanDenKerkhof, E. G., Goldstein, D. H., Twagirumugabe, T., Mahaffey, R., Parlow, J., & Johnson, A. P. (2018). Barriers and facilitators to postoperative pain management in Rwanda from the perspective of health care providers: A contextualization of the theory of planned behavior. Canadian Journal of Pain, 2(1), 87–102. https://doi.org/10.1080/24740527.2018.1451251

Onishi, E., Kobayashi, T., Dexter, E., Marino, M., Maeno, T., & Deyo, R. A. (2017). Comparison of opioid prescribing patterns in the United States and Japan: Primary care physicians’ attitudes and perceptions. Journal of the American Board of Family Medicine, 30(2), 248–254. https://doi.org/10.3122/jabfm.2017.02.160299

Pai, R. S., Monteiro, G., & Tarey, S. D. (2021). Attitudes, aptitudes, barriers and knowledge of pain physicians towards palliative care practice - A national survey, India. Indian Journal of Palliative Care, 27(2), 242–250. https://doi.org/10.25259/IJPC_325_20

Polacek, C., Christopher, R., Mann, M., Udall, M., Craig, T., Deminski, M., & Sathe, N. A. (2020). Healthcare professionals’ perceptions of challenges to chronic pain management. The American Journal of Managed Care, 26(4), E135–E139. https://doi.org/10.37765/AJMC.2020.42841

Posadzki, P., Mastellos, N., Ryan, R., Gunn, L. H., Felix, L. M., Pappas, Y., Gagnon, M. P., Julious, S. A., Xiang, L., Oldenburg, B., & Car, J. (2016). Automated telephone communication systems for preventive healthcare and management of long-term conditions. Cochrane Database of Systematic Reviews, 2016(12). https://doi.org/10.1002/14651858.CD009921.PUB2

Rodondi, P. Y., Dubois, J., Bill, A. S., Koutaïssoff, D., Ros, J., Aveni, E., Pasquier, J., Herzig, L., Decosterd, I., & Burnand, B. (2019). Primary care physicians’ attitude and reported prescribing behavior for chronic low back pain: An exploratory cross-sectional study. PLoS ONE, 13(9). https://doi.org/10.1371/JOURNAL.PONE.0204613

Varrassi, G., & Müller-Schwefe, G. H. H. (2012). The international CHANGE PAIN physician survey: Does specialism influence the perception of pain and its treatment? Current Medical Research and Opinion, 28(5), 823–831. https://doi.org/10.1185/03007995.2012.674499

Yang, S. Y., Bogosian, A., Moss-Morris, R., & McCracken, L. M. (2016). Healthcare professionals’ perceptions of psychological treatment for chronic pain in Singapore: challenges, barriers, and the way forward. Disability and Rehabilitation, 38(17), 1643–1651. https://doi.org/10.3109/09638288.2015.1107635
Relief Into Paediatrics: A WHO Guide for Health Care Planners, Implementers and Managers. World Health Organization; 2018.
2. Weaver MS, Heinze KE, Kelly KP, et al. Palliative care as a standard of care in pediatric oncology. Pediatr Blood Cancer. 2015;62(suppl 5):S829-S833.
3. Wolfe J, Hammel JF, Edwards KE, et al. Easing of suffering in children with cancer at the end of life: is care changing? J Clin Oncol. 2008;26:1717-1723.
4. Groh G, Borasio GD, Nickolay C, Bender HU, von Luttichau I, Fuhrer M. Specialized pediatric palliative home care: a prospective evaluation. J Palliat Med. 2013;16:1588-1594.
5. Groh G, Vyhnalek B, Feddersen B, Fuhrer M, Borasio GD. Effectiveness of a specialized outpatient palliative care service as experienced by patients and caregivers. J Palliat Med. 2013;16:848-856.
6. Vollenbroich R, Duroux A, Grasser M, Brandstatter M, Borasio GD, Fuhrer M. Effectiveness of a pediatric palliative home care team as experienced by parents and health care professionals. J Palliat Med. 2012;15:294-300.
7. Snaman JM, Kaye EC, Lu JJ, Sykes A, Baker JN. Palliative care involvement is associated with less intensive end-of-life care in adolescent and young adult oncology patients. J Palliat Med. 2017;20:509-516.
8. Reid EA, Kovalerchik O, Jubanyik K, Brown S, Hersey D, Grant L. Is palliative care cost-effective in low-income and middle-income countries? A mixed-methods systematic review. BMJ Support Palliat Care. 2019;9:120-129.
9. Kaye EC, DeMarsh S, Gushue CA, et al. Predictors of location of death for children with cancer enrolled on a palliative care service. Oncologist. 2018;23:1525-1532.
10. Levine DR, Johnson LM, Snyder A, et al. Integrating palliative care in pediatric oncology: evidence for an evolving paradigm for comprehensive cancer care. J Natl Compr Canc Netw. 2016;14:741-748.
11. Schmidt P, Otto M, Hechler T, Metzing S, Wolfe J, Zernikow B. Did increased availability of pediatric palliative care lead to improved palliative care outcomes in children with cancer? J Palliat Med. 2013;16:1034-1039.

Presenting Author: Narine Movsisyan
Submitting Author: Narine Movsisyan

Senior Author: Narine Movsisyan

IASP 2026 Global Year theme of Neuropathic Pain: No