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Review Article Volume 17 issue 5
Overcoming barriers to chronic pain management in primary care: a narrative review of multimodal strategies, opioid stewardship, and specialty referral pathways
Roy Sebastian, Jonathan Saju BS, Thelma Wright
Received: September 29, 2026 | Published: October 6, 2026
Citation: Sebastian R, Saju JBS, Wright T. Overcoming barriers to chronic pain management in primary care: a narrative review of multimodal strategies, opioid stewardship, and specialty referral pathways. J Cancer Prev Curr Res. 2026;17(4):149‒154. DOI: 10.15406/jcpcr.2026.17.00622
Abstract
Chronic pain is a leading cause of global disability and a major public health concern, imposing massive socioeconomic burdens. Primary care physicians (PCPs) are central to managing this heterogeneous population, yet they routinely face severe clinical, educational, and systemic challenges. This narrative review outlines the scope of chronic pain management in primary care, examines key barriers faced by PCPs, and provides an evidence-based framework for multimodal treatment, opioid stewardship, and specialist referral. A comprehensive literature search was conducted across PubMed, EMBASE, and Google Scholar for English-language systematic reviews, clinical guidelines, and observational studies published between 2005 and 2026. Effective primary care pain management relies on a holistic, multimodal strategy prioritizing non-pharmacological interventions and non-opioid pharmacotherapy. Key barriers to optimal care include deficient medical school education on pain, brief consultation times, poor insurance reimbursement for non-procedural services, and limited interdisciplinary resources. Opioids should remain a non-first-line option, utilized only when functional benefits outweigh risks, and managed via strict risk-mitigation strategies. Clear pathways for pain specialist referrals are indicated for diagnostic uncertainty, refractory pain, or complex opioid management. Being a narrative review, there might be a risk of selection bias in this paper as well as lack of quantification of results. The limitations of the study include heterogeneity among the studies, guidelines, and healthcare setting, which may lead to non-generalization of the study findings. Further research conducted after the completion of the study period can also impact future clinical practice. PCPs are integral to chronic pain management but remain constrained by structural and educational limitations. Improving patient outcomes requires systemic shifts toward integrated care models, enhanced clinician education, and robust collaboration between primary care and specialty pain services to support effective multimodal treatment and opioid stewardship.
Keywords: chronic pain, primary care, pain management, opioid stewardship, pain specialists
©2026 Sebastian, et al. This is an open access article distributed under the terms of the, which permits unrestricted use, distribution, and build upon your work non-commercially.