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Preferences, Experience, and Attitudes in the Management of Chronic Pain and Depression: A Comparison of Physicians and Medical Students

Hirsh, Adam T. PhD*; Hollingshead, Nicole A. MS*; Bair, Matthew J. MD†,‡,§; Matthias, Marianne S. PhD†,‡; Kroenke, Kurt MD†,‡,§

doi: 10.1097/AJP.0000000000000035
Original Articles

Objectives: The current study investigated clinicians’ treatment preferences for chronic pain and depression and the extent to which these preferences were related to clinicians’ experience and attitudes.

Methods: Eighty-five participants (50 physicians, 35 medical students) made treatment recommendations for 8 virtual patients with chronic low back pain and depression. The 10 treatment options included pharmacological and nonpharmacological approaches. Participants also provided information about their clinical experience and completed measures assessing their attitudes toward patients with pain and depression.

Results: The highest recommended treatments were over-the-counter medications and topical modalities, whereas “no intervention,” referral to a pain specialist, and opioid medication received the lowest ratings. Physicians gave higher ratings to physical therapy (P<0.05) and lifestyle activities (P<0.05) than did medical students. Students reported more negative attitudes about patients with depression (P<0.05) than did physicians. After controlling for participants’ attitudes, the treatment preference×training level interaction was no longer significant (P>0.05).

Discussion: Physicians and medical students shared a general preference for “low-risk,” self-management approaches for chronic pain and depression; however, they differed in their recommendations for some specific treatments. Participants’ attitudes toward patients with pain and depression were associated with their preferences and accounted for the differences in their treatment decisions. These results suggest a need for early and continuing education to reduce clinicians’ negative attitudes toward and improve the management of patients with chronic pain and depression.

*Department of Psychology, Indiana University—Purdue University Indianapolis

VA HSR&D Center of Excellence on Implementing Evidence-Based Practice, Roudebush VA Medical Center

Regenstrief Institute Inc.

§Department of Medicine, Indiana University School of Medicine, Indianapolis, IN

Supported by the Indiana University Collaborative Research Grant (IUCRG) fund of the Office of the Vice President for Research, Bloomington, IN and a Release Time for Research (RTR) grant from the IUPUI Office of the Vice Chancellor for Research, Indianapolis, IN. The authors declare no conflict of interest.

Reprints: Adam T. Hirsh, PhD, Department of Psychology, Indiana University—Purdue University Indianapolis, 402 N. Blackford, Indianapolis, IN 46202 (e-mail:

Received July 10, 2013

Received in revised form October 7, 2013

Accepted September 9, 2013

© 2014 by Lippincott Williams & Wilkins