Challenges in pain management and opioid prescribing practices following traumatic injury: a focus group study with orthopedic surgeons and general practitioners

To explore the experiences of orthopedic surgeons and general practitioners (GPs) in providing pain management, focusing on opioid prescribing practices and follow-up care for trauma patients following orthopedic injuries. Four semi-structured focus group interviews were conducted among 18 physicians, two among GPs and two among orthopedic trauma surgeons. Each group consisted of either specialist candidates or experienced specialists. The interviews explored experiences with follow-up care for orthopedic trauma patients, pain management, including opioid use and tapering, and were thematically analyzed. Four main themes were identified: (1) Navigating post-discharge pain management, where GPs experienced problematic transfer of treatment responsibility and lack of opioid taper plans from the specialist health service. (2) A knowledge gap in pain management, with GPs reporting insufficient knowledge about opioid treatment, and orthopedic residents describing lacking systematic training in this area during specialization. (3) Changes in opioid prescribing practices over time, which had led to a self-perceived shift from liberal to restrictive prescription attitudes. (4) Unrealistic expectations of pain relief among patients were perceived by GPs and orthopedic surgeons throughout recovery. Our findings reveal a knowledge gap in pain management, suggesting a need for enhanced education and training for GPs, both in specialization and specialist, and for orthopedic residents. This is crucial to meet the needs of trauma patients with severe orthopedic injuries and long-term pain. GPs need access to advisory support from the specialist healthcare system. These resources, including follow-up during challenging recovery phases, must be accessible to enhance patients care.