Chronic pain management - can we do better? An interview-based survey in primary care

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 CNMR 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.