The Challenges of Pain Management in Primary Care: a Pan-European Survey

Overview

Journal J Pain Res

Publisher Dove Medical Press

Date 2013 Jun 1

PMID 23723719

Citations 33

Authors

Martin Johnson

Beverly Collett

Jose M Castro-Lopes

Affiliations

Soon will be listed here.

Abstract

Background: 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.

Objective: 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.

Methods: 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).

Results: 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.

Conclusion: 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.

Citing Articles

Problems accessing pain care, and the adverse outcomes among adults with chronic pain: a cross-sectional survey study.

Carrillo M, Yingst J, Tuan W, Giampetro D, Nyland J, Zgierska A Pain Manag. 2025; 15(2):81-91.

PMID: 39936847 PMC: 11853623. DOI: 10.1080/17581869.2025.2463865.

Recognition at the Heart of the Complex Situations Experienced by People With Chronic Musculoskeletal Pain.

Jessica M, Aurelie B, Fabian D, Quentin V, Lea D, Marco S Health Expect. 2024; 28(1).

PMID: 39737654 PMC: 11683188. DOI: 10.1111/hex.70129.

Exploring Factors Associated with Prescribers' Comfort Levels in Analgesic Prescribing in Quebec.

Naeem U, De Clifford-Faugere G, Godbout-Parent M, Nguena Nguefack H, Lacasse A J Pain Res. 2024; 17:2667-2677.

PMID: 39165720 PMC: 11334923. DOI: 10.2147/JPR.S469052.

Designing a primary care pharmacist-led review for people treated with opioids for persistent pain: a multi-method qualitative study.

Woodcock C, Cornwall N, Dikomitis L, Harrisson S, White S, Helliwell T BJGP Open. 2024; 8(3).

PMID: 38631722 PMC: 11523508. DOI: 10.3399/BJGPO.2023.0221.

Physician perspectives on chronic pain management: barriers and the use of eHealth in the COVID-19 era.

Kaseweter K, Nazemi M, Gregoire N, Louw W, Walsh Z, Holtzman S BMC Health Serv Res. 2023; 23(1):1131.

PMID: 37864210 PMC: 10588239. DOI: 10.1186/s12913-023-10157-8.

References

Lewis E, Trafton J . Opioid use in primary care: asking the right questions. Curr Pain Headache Rep. 2011; 15(2):137-43. DOI: 10.1007/s11916-010-0172-0. View

Niemi-Murola L, Nieminen J, Kalso E, Poyhia R . Medical undergraduate students' beliefs and attitudes toward pain: how do they mature?. Eur J Pain. 2007; 11(6):700-6. DOI: 10.1016/j.ejpain.2006.12.001. View

Breivik H, Collett B, Ventafridda V, Cohen R, Gallacher D . Survey of chronic pain in Europe: prevalence, impact on daily life, and treatment. Eur J Pain. 2005; 10(4):287-333. DOI: 10.1016/j.ejpain.2005.06.009. View

Spitz A, Moore A, Papaleontiou M, Granieri E, Turner B, Reid M . Primary care providers' perspective on prescribing opioids to older adults with chronic non-cancer pain: a qualitative study. BMC Geriatr. 2011; 11:35. PMC: 3212901. DOI: 10.1186/1471-2318-11-35. View

Chou R, Ballantyne J, Fanciullo G, Fine P, Miaskowski C . Research gaps on use of opioids for chronic noncancer pain: findings from a review of the evidence for an American Pain Society and American Academy of Pain Medicine clinical practice guideline. J Pain. 2009; 10(2):147-59. DOI: 10.1016/j.jpain.2008.10.007. View

Scholz J, Mannion R, Hord D, Griffin R, Rawal B, Zheng H . A novel tool for the assessment of pain: validation in low back pain. PLoS Med. 2009; 6(4):e1000047. PMC: 2661253. DOI: 10.1371/journal.pmed.1000047. View

Briggs E, Carr E, Whittaker M . Survey of undergraduate pain curricula for healthcare professionals in the United Kingdom. Eur J Pain. 2011; 15(8):789-95. DOI: 10.1016/j.ejpain.2011.01.006. View

Gooberman-Hill R, Heathcote C, Reid C, Horwood J, Beswick A, Williams S . Professional experience guides opioid prescribing for chronic joint pain in primary care. Fam Pract. 2010; 28(1):102-9. DOI: 10.1093/fampra/cmq083. View

Wenghofer E, Wilson L, Kahan M, Sheehan C, Srivastava A, Rubin A . Survey of Ontario primary care physicians' experiences with opioid prescribing. Can Fam Physician. 2011; 57(3):324-32. PMC: 3056687. View

10.

Rosti G, Gatti A, Costantini A, Sabato A, Zucco F . Opioid-related bowel dysfunction: prevalence and identification of predictive factors in a large sample of Italian patients on chronic treatment. Eur Rev Med Pharmacol Sci. 2011; 14(12):1045-50. View

11.

Moore R, McQuay H . Prevalence of opioid adverse events in chronic non-malignant pain: systematic review of randomised trials of oral opioids. Arthritis Res Ther. 2005; 7(5):R1046-51. PMC: 1257433. DOI: 10.1186/ar1782. View

12.

Dobscha S, Corson K, Flores J, Tansill E, Gerrity M . Veterans affairs primary care clinicians' attitudes toward chronic pain and correlates of opioid prescribing rates. Pain Med. 2008; 9(5):564-71. DOI: 10.1111/j.1526-4637.2007.00330.x. View

13.

Tai-Seale M, Bolin J, Bao X, Street R . Management of chronic pain among older patients: inside primary care in the US. Eur J Pain. 2011; 15(10):1087.e1-8. PMC: 3208766. DOI: 10.1016/j.ejpain.2011.06.012. View

14.

Corrigan C, Desnick L, Marshall S, Bentov N, Rosenblatt R . What can we learn from first-year medical students' perceptions of pain in the primary care setting?. Pain Med. 2011; 12(8):1216-22. DOI: 10.1111/j.1526-4637.2011.01150.x. View

15.

Bell T, Panchal S, Miaskowski C, Bolge S, Milanova T, Williamson R . The prevalence, severity, and impact of opioid-induced bowel dysfunction: results of a US and European Patient Survey (PROBE 1). Pain Med. 2008; 10(1):35-42. DOI: 10.1111/j.1526-4637.2008.00495.x. View

16.

Leverence R, Williams R, Potter M, Fernald D, Unverzagt M, Pace W . Chronic non-cancer pain: a siren for primary care--a report from the PRImary Care MultiEthnic Network (PRIME Net). J Am Board Fam Med. 2011; 24(5):551-61. DOI: 10.3122/jabfm.2011.05.110030. View

17.

Green C, Wheeler J, Marchant B, Laporte F, Guerrero E . Analysis of the physician variable in pain management. Pain Med. 2004; 2(4):317-27. DOI: 10.1046/j.1526-4637.2001.01045.x. View

18.

Nwokeji E, Rascati K, Brown C, Eisenberg A . Influences of attitudes on family physicians' willingness to prescribe long-acting opioid analgesics for patients with chronic nonmalignant pain. Clin Ther. 2008; 29 Suppl:2589-602. DOI: 10.1016/j.clinthera.2007.12.007. View

19.

Clark L, Upshur C . Family medicine physicians' views of how to improve chronic pain management. J Am Board Fam Med. 2007; 20(5):479-82. DOI: 10.3122/jabfm.2007.05.070029. View

20.

Sinatra R . Opioid analgesics in primary care: challenges and new advances in the management of noncancer pain. J Am Board Fam Med. 2006; 19(2):165-77. DOI: 10.3122/jabfm.19.2.165. View