Cathy Stannard; Martin Johnson

Curr Med Res Opin 19(8):703-706, 2003. © 2003 Librapharm Limited
Posted 02/11/2004
Summary and Introduction
Summary

Background: Persisting pain is demoralising and debilitating for patients and their carers. Most patients with chronic pain do not need the services of a specialised pain clinic and are appropriately managed by their general practitioner (GP).
Method: Interviewers approached 569 GPs to assess their satisfaction with the management of patients with chronic non-malignant (i.e. non-cancer related) pain (CNMP). The survey was carried out from November 2001 to January 2002 in general practices in the UK. GPs were randomly selected as representative of the basic population who treat CNMP. The survey was conducted in a face-to-face interview in the GP surgery using a questionnaire consisting of 35 open questions covering practice information, treatment of CNMP, pain management and multidisciplinary support.
Results: 504 (88.6%) of GPs completed the structured questionnaire. 81% of GPs believed that a significant number of patients received suboptimal management. Optimal control of symptoms was estimated to occur in less than half of patients. The main barriers to achieving good pain control were identified as side-effects of therapies (74%) and patient compliance (58%). 60% of respondents expressed concerns regarding efficacy of available therapies. Although 91% of GPs considered specialised pain services as beneficial, only 14% of patients were referred to hospital for symptom management. 96% of GPs felt that the management of chronic pain could be improved in their locality and 81% expressed an interest in relevant training.
Conclusion: Most GPs believe that the management of chronic pain can be improved. Further education of all healthcare professionals who manage patients in pain is needed to bring about such a change.
Introduction

Pain is the most commonly perceived symptom in adults[1] and a very common complaint in patients who seek the help of healthcare professionals.[2] In 1998, a survey carried out by the World Health Organization of 26 000 primary care patients estimated that 22% of patients reported persistent pain over the previous year.[3] A British survey reported a high prevalence of current and chronic (continuous) pain, as well as a high degree of associated disabilities and limitations.[4] Estimates of the prevalence of chronic pain vary considerably (ranging from 7% to 55%) in the published literature.[5-7] This variability is to be expected, as there is considerable heterogeneity in definitions of chronic pain, populations studied and survey methods in these studies. Arthritis and back pain are consistently and prominently reported.[4,7,8] This latter represents a considerable economic burden in the form of health and social costs[9,10] and accounts for at least 14 million general practice consultations annually in the UK.[11] Despite these figures, the relief of persistent pain is not currently, nor is likely to be in the near future, a healthcare priority in the UK. Improved confidence in the management of chronic pain in primary care and by the many specialists with whom these patients come into contact is more likely to benefit patients than expansion of specialist pain services, which are struggling to meet demand.

We have investigated whether our medical colleagues in primary care were satisfied with the management of chronic (persisting) pain.

Method

We carried out a survey (from November 2001 to January 2002) in general practices throughout the UK. Practices in Scotland, Northern Ireland and throughout England were represented. GPs were randomly selected as representative of the basic population who treat chronic non-malignant pain (CNMP). A total of 569 GPs were approached to take part. It was explained that this was a nationwide survey and that results would not be available on an individual practice level. The interview was conducted by a