Results Summary

What was the research about?

Acute pain, like severe back pain, headache, or joint and muscle pain, is a common health problem that can limit function and well-being. Medicines called opioids can help ease acute pain. But long-term opioid use can lead to addiction or overdose.

Clinical practice guidelines identify prescribing practices that clinicians, like doctors or nurses, should avoid when using opioids to treat acute pain. Unsafe practices may include prescribing high levels of opioids or long-acting opioids at a patient’s first visit.

In this study, the research team compared four ways to help clinicians treat acute pain safely. They looked at the effect on patients’ pain and on reducing unsafe opioid prescribing. The four ways were:

  • Guideline alone. The electronic health record, or EHR, displayed the guideline when the clinician wanted to prescribe an opioid.
  • Guideline plus reason for prescribing. The EHR displayed the guideline. If the clinician wanted to prescribe the opioid, they had to enter a reason into the EHR.
  • Guideline plus comparison report. The EHR displayed the guideline. Also, the clinician received a monthly email that compared how often they prescribed opioids for acute pain and how well they followed the guideline versus their peers.
  • Guideline plus reason and comparison report. The EHR displayed the guideline. The clinician also entered a reason for prescribing opioids and received the monthly email.

What were the results?

Compared with clinicians who received the guideline alone, clinicians who entered a reason for prescribing and received a comparison report had lower rates of prescribing opioids.

The four ways didn’t differ in:

  • The percentage of patients whose doctors had unsafe opioid prescribing practices
  • Patients' pain levels
  • The percentage of patients who continued using opioids long term

Who was in the study?

The study included 22,616 adults with acute pain. All received care from one of 48 clinics in three health systems in Pennsylvania and Utah. Patients had not used opioids for at least one year. Of patients, 84 percent were White, 5 percent were Black, 3 percent were Asian, and 8 percent were another race or unknown race; 8 percent were Hispanic. The average age was 49, and 57 percent were men.

What did the research team do?

The research team assigned clinics by chance to one of the four ways. The team looked at EHRs to see if clinicians prescribed opioids to patients at their first visit. The team also assessed unsafe prescribing practices after 3, 6, and 12 months. Patients completed surveys about their pain levels 1, 6, and 12 months after their first visit.

Patients with acute pain, clinicians, and health insurers helped design the study.

What were the limits of the study?

Most patients in the study were White. Results may differ for patients of other racial and ethnic backgrounds.

Future research could test other ways to help clinicians reduce unsafe opioid prescribing.

How can people use the results?

Clinics can use the results when considering how to help clinicians prescribe opioids safely.

How this project fits under PCORI’s Research Priorities
The research reported in this results summary was conducted using PCORnet®, the National Patient-Centered Clinical Research Network. PCORnet® is intended to improve the nation’s capacity to conduct health research, particularly comparative effectiveness research (CER), efficiently by creating a large, highly representative network for conducting clinical outcomes research. PCORnet® has been developed with funding from the Patient-Centered Outcomes Research Institute® (PCORI®).

PCORI identified unsafe opioid prescribing as an important research topic. Patients, clinicians, and others wanted to learn: How can primary care providers work with patients with non-cancer pain to plan safe treatment and provide adequate pain management? To help answer this question, PCORI launched an initiative in 2016 on Strategies to Prevent Unsafe Opioid Prescribing in Primary Care among Patients with Acute or Chronic Noncancer Pain. The initiative funded this research project and others.

Final Research Report

This project's final research report is expected to be available by June 2023. 

Peer-Review Summary

The Peer-Review Summary for this project will be posted here soon.

Project Information

Kevin Kraemer, MD
University of Pittsburgh
Provider-Targeted Behavioral Interventions to Prevent Unsafe Opioid Prescribing for Acute Non-Cancer Pain in Primary Care

Key Dates

August 2017
November 2022

Study Registration Information


Has Results
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Intervention Strategy Intervention Strategies PCORI funds comparative clinical effectiveness research (CER) studies that compare two or more options or approaches to health care, or that compare different ways of delivering or receiving care. View Glossary
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Last updated: November 30, 2022