Revista de la Sociedad Española del Dolor
versión impresa ISSN 1134-8046
GONZALEZ-ESCALADA, J.R. et al. Beliefs, attitudes and perceptions of physicians, pharmacists and patients regarding the evaluation and treatment of chronic nononcologic pain. Rev. Soc. Esp. Dolor [online]. 2009, vol.16, n.1, pp.7-20. ISSN 1134-8046.
Aim: to identify patients', physicians' and pharmacists' attitudes, personal beliefs, experiences and opinions regarding chronic nononcological pain and to determine how these attitudes influence the choice and follow-up of analgesic strategies. Material and methods: design: we performed a descriptive, cross-sectional survey that included three distinct but comparable questionnaires for data collection, adapted to each subgroup: 316 pharmacists and 838 patients were interviewed by telephone, and 697 physicians from different specialties completed a self-administered questionnaire. The variables analyzed included sociodemographic data from each group, descriptive pain variables (prevalence of pain among their patients, pain characteristics [e.g. localization, intensity -visual-analog pain scale, VAS, from 0 "no pain" to 10 "maximum tolerable pain"- frequency, duration, consequences, among others]), and questions related to analgesic treatment (objectives, drug choice and prescription, information provided and received on analgesic drugs, and satisfaction and concerns). Data analysis consisted of a descriptive analysis of the characteristics of each group, followed by analysis of intergroup differences. Results: a) physicians: 60% reported that they usually assessed pain intensity in their patients, using VAS (68%) or verbal rating scales (VRS) (36%). Forty-seven percent of the patients attended weekly had pain, which was uncontrolled (VAS score ≥ 4 points) in 63%. The goal of treatment was to improve patients' quality of life rather than to relieve pain. Strong opioids were only prescribed in 17% of patients, mainly in pain treatment units (PTU), where most patients with chronic nononcologic pain and high-intensity pain were treated and where physicians were most concerned about the effects of pain on patients' daily lives. Rehabilitation physicians were more reluctant to use opioids because of their adverse effects and the need to use a special prescription form; b) pharmacists: 65% reported no reluctance to use strong opioids, and 63% believed that this attitude was shared by patients. Pharmacists believed that the goals of treatment were to achieve pain relief until pain was tolerable or absent; c) patients: patients' perceptions of pain intensity assessment differed from that of physicians, since 87% of patients reported that their physician measured pain at each visit, 6% with VAS and 71% with VRS. For patients, the goal of treatment was to achieve tolerable pain levels. Twenty-three percent were reluctant to use strong opioids due to their adverse effects and their fear of becoming addicts. Conclusion: the results of this study highlight the complex and multifactorial nature of pain treatment, requiring the design of improved intervention strategies. Factors to be considered are the high prevalence of uncontrolled pain, the low use of strong opioids, discrepancies in the frequency and methods used for systematic pain assessment, the existence of treatment concerns due to lack of information, and the perception that special regulation of opioids acts a barrier to their prescription.
Palabras clave : Chronic non oncologic pain; Pain unit; Pain management; Quality of life; Opioids.