The challenges of pain management in primary care: A pan-European survey

Community Pain Medicine, Cardiff University, Cardiff, UK.
Journal of Pain Research 05/2013; 6:393-401. DOI: 10.2147/JPR.S41883
Source: PubMed


The OPENMinds Primary Care group is a group of European primary care physicians (PCPs) with an interest in pain management, formed to improve the understanding and management of chronic pain in primary care.
A survey was conducted to assess the challenges of chronic nonmalignant pain (CNMP) management in primary care in Europe, focusing particularly on pain assessment, opioid therapy, and educational needs.
A questionnaire was developed for online use by PCPs in 13 European countries (Belgium, Denmark, France, Germany, Ireland, Italy, the Netherlands, Norway, Poland, Portugal, Spain, Sweden, and the UK).
A total of 1309 PCPs completed the questionnaire, approximately 100 from each country. Most PCPs (84%) perceived CNMP to be one of the most challenging conditions to treat, yet a low priority within healthcare systems. Only 48% of PCPs used pain assessment tools, and 81% considered chronic pain and its impact on quality of life to be underassessed in primary care. PCPs were less confident about prescribing strong opioids for CNMP than for use in cancer pain. Most PCPs (84%) considered their initial training on CNMP was not comprehensive, with 89% recognizing a need for more education on the topic.
These findings reveal that PCPs in Europe find CNMP a challenge to treat. Areas to address with training include underuse of pain assessment tools and lack of confidence in use of opioid therapy. Guidelines on CNMP management in primary care would be welcomed. The insights gained should provide the basis for future initiatives to support primary care management of chronic pain.

15 Reads
  • Source
    • "Opioids have become the most frequently used drugs for the treatment of chronic pain [1] and are a major component of the WHO-prescribed approach of stepwise escalation of analgesic treatment with increased pain intensity [9] [10]. Although the WHO-prescribed approach has been adopted, as intended, for treatment of chronic cancer pain, it has been, despite expert recommendations, only slowly adopted in the treatment of chronic noncancer pain, which mostly occurs in primary care [11] [12]. Fentanyl is a potent opioid and a treatment option at the top (step 3) of the WHO pain treatment ladder [13]. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Fentanyl is considered to be an effective, transdermal treatment of chronic, cancer, and noncancer pain. This noninterventional, clinical practice-based study, on 426 patients attending 42 practices, assessed a proprietary, Aloe vera-containing, transdermal fentanyl matrix patch (Fentavera), for its analgesic effects, patients’ quality of life (QoL) effects, tolerability, and adhesiveness. Study outcomes were mean changes from baseline of patient (11-point scales) and physician (5-point scales) ratings. After 1 and 2 months treatment, there were significant () decreases in patients’ ratings of pain intensity, and impairment of walking, general activity, sleep quality, and QoL. For each parameter, the patient response rate was >30% at 2 months (response = 2-point decrease on 11-point rating scale). In a large majority of patients, the physicians rated the matrix patch as good or very good for analgesic effect, systemic and local tolerance, and adhesiveness. There were 30 adverse events in 4.2% of patients and analgesic comedications were reduced during treatment compared to before treatment. It is concluded, from this population-based data, that the proprietary, transdermal fentanyl matrix patch is effective and safe for chronic pain management in clinical practice, with significant positive analgesic and QoL effects, while being well tolerated and exhibiting good or very good adhesiveness.
    Pain Research and Treatment 04/2015; 2015:1-9. DOI:10.1155/2015/198343
  • Source

    European geriatric medicine 09/2013; 4:S156. DOI:10.1016/j.eurger.2013.07.519 · 0.73 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: This article describes the rationale for the creation of pain medicine as a subspecialty in Canada and outlines a brief history of its development. For pain medicine to be designated a Royal College subspecialty, it had to meet three requirements: offer sufficient scientific breadth and depth, prove a clearly identifiable unique field of practice, and show a societal need. The application process for subspecialty status was initiated in 2007, and it is anticipated that the first trainees in pain medicine will start their training in July 2014. This article outlines the variety of Royal College subspecialty entry routes as well as the proposed training objectives, curriculum, assessment of competency, practice-eligibility route to certification, and accreditation of training programs across Canada. With the inception of this subspecialty, the treatment of acute pain, cancer pain, and chronic non-cancer pain will be further integrated within the Canadian healthcare system.
    Canadian Anaesthetists? Society Journal 12/2013; 61(2). DOI:10.1007/s12630-013-0068-7 · 2.53 Impact Factor
Show more


15 Reads
Available from