Pflughaupt M, Scharnagel R, Gossrau G, Kaiser U, Koch T, Sabatowski R
Klinik und Poliklinik für Anästhesiologie und Intensivtherapie, Universitätsklinikum Carl Gustav Carus, Technische Universität Dresden, Dresden, Deutschland.
Schmerz. 2010 Jun;24(3):267-75. doi: 10.1007/s00482-010-0913-3.
The efficacy of opioids has been proved and several guidelines and expert panel-based recommendations regarding the use of opioids in different pain syndromes are available. Nevertheless, undertreatment of pain with strong opioids was reported in previous studies. It was shown that physicians' lack of knowledge, their concerns and misconceptions about the opioid use and the controlled substances regulations that govern the prescriptions of opioids occasionally contribute to insufficient pain treatment. This study was designed to evaluate German physicians' knowledge and their concerns about the use of opioids.
During a postgraduate course a questionnaire was completed by German physicians specializing in pain therapy.
A total of 226 physicians completed the questionnaire (response rate 57%). Many of them had poor knowledge of the WHO recommendations for the treatment of cancer pain including the WHO analgesic ladder. Deficiencies in the knowledge of pharmacological aspects and controlled substances regulations were revealed. Many physicians would prescribe strong opioids for non-opioid-sensitive types of pain. The concerns regarding opioid therapy included adverse effects and addiction. In contrast to earlier findings the German controlled substances regulations no longer seem to be a barrier to the prescription of opioids in the treatment of chronic severe pain since they were changed in 1998. As a result, the lack of knowledge and the physicians' concerns about the use of opioids as shown in this survey may likely lead to an insufficient treatment of patients suffering from severe chronic pain.
It is necessary to improve the medical students' education and the physicians' postgraduate training regarding principles of pain management such as the WHO guidelines for the treatment of cancer pain. A better knowledge of important pharmacological aspects of opioids should help to reduce physicians' concerns about the use of strong opioids. Nevertheless, improvement of physicians' skills in pain therapy is only one aim in a multidisciplinary concept in order to improve patients' pain therapy.
阿片类药物的疗效已得到证实，并且有一些关于在不同疼痛综合征中使用阿片类药物的指南和基于专家小组的建议。然而，先前的研究报告称，强效阿片类药物对疼痛的治疗不足。研究表明，医生缺乏相关知识、他们对阿片类药物使用的担忧和误解以及管理阿片类药物处方的管制药品法规，偶尔会导致疼痛治疗不足。本研究旨在评估德国医生对阿片类药物使用的知识和担忧。
在一门研究生课程中，专门从事疼痛治疗的德国医生填写了一份问卷。
共有226名医生完成了问卷（回复率为57%）。他们中的许多人对世界卫生组织（WHO）关于癌症疼痛治疗的建议（包括WHO镇痛阶梯）了解不足。在药理学方面和管制药品法规知识方面存在欠缺。许多医生会为对阿片类药物不敏感的疼痛类型开具强效阿片类药物。对阿片类药物治疗的担忧包括不良反应和成瘾。与早期研究结果不同，自1998年德国管制药品法规更改后，它们似乎不再是慢性重度疼痛治疗中开具阿片类药物处方的障碍。因此，本次调查中显示的医生对阿片类药物使用的知识缺乏和担忧，可能会导致对重度慢性疼痛患者的治疗不足。
有必要改进医学生关于疼痛管理原则（如WHO癌症疼痛治疗指南）的教育以及医生的研究生培训。更好地了解阿片类药物的重要药理学方面，应有助于减少医生对使用强效阿片类药物的担忧。然而，提高医生在疼痛治疗方面的技能只是多学科概念中的一个目标，目的是改善患者的疼痛治疗。
