Teramo ASL, Teramo, Italy
Curr Med Res Opin. 2012 May;28(5):823-31. doi: 10.1185/03007995.2012.674499. Epub 2012 Apr 25.
This survey explores how physicians perceive chronic non-cancer pain, and examines their opinions on current treatment options.
The computer-based survey comprises a questionnaire that is completed by physicians, mostly at professional conferences and congresses, but also online. The focus is on pain specialists, primary care physicians and other specialists (such as neurologists and rheumatologists), to discover any differences in their approach to treating chronic non-cancer pain.
No common understanding existed of where severe pain starts on an 11-point Numeric Rating Scale. Overall, two-thirds of respondents aim for treatment to reduce pain intensity to an NRS score of 2-4, with primary care physicians tending to aim for lower scores. All three groups considered reduction of pain to be the most important treatment goal, followed by quality of life. Asked to rank the most important factors when choosing an analgesic agent to treat severe, chronic non-cancer pain, respondents ranked efficacy first, tolerability second, and quality of life third. In each rank, more primary care physicians chose these options than in the specialist groups. More pain specialists used classical strong opioids often or very often - and for longer - than did physicians in the other two groups. Nausea/vomiting, bowel dysfunction and somnolence were ranked the first, second and third main reasons, respectively, for treatment failure with these agents. Over 90% of respondents used combination treatment rather than monotherapy to treat severe, chronic pain, but no fewer than 176 different combinations were cited.
Pain reduction and improvement in quality of life are the most important treatment goals. Wide variation in treatment indicates that no single drug is particularly good for managing chronic pain, and suggests that current treatment is not evidence-based. Differences between the groups imply that first-line treatment is more cautious and conventional. The key limitations of this survey include its small sample size, informal implementation and lack of detail regarding the respondents surveyed.
本调查探讨了医生对慢性非癌性疼痛的看法，并考察了他们对当前治疗选择的意见。
这项基于计算机的调查包括一份问卷，由医生填写，主要在专业会议和大会上填写，但也可以在线填写。重点是疼痛专家、初级保健医生和其他专家（如神经病学家和风湿病学家），以发现他们治疗慢性非癌性疼痛的方法有何不同。
在 11 点数字评定量表上，没有医生对严重疼痛起始点达成共识。总的来说，三分之二的受访者希望治疗能将疼痛强度降低到 NRS 评分 2-4，初级保健医生倾向于将目标设定得更低。三组患者均认为减轻疼痛是最重要的治疗目标，其次是生活质量。在选择镇痛药治疗严重慢性非癌性疼痛时，要求受访者按重要性对因素进行排序，结果显示，疗效排名第一，可耐受性排名第二，生活质量排名第三。在每个排名中，选择这些选项的初级保健医生比专科医生多。更多的疼痛专家经常或非常频繁地使用经典强效阿片类药物，而且时间更长，而非专科医生使用的频率较低。恶心/呕吐、肠道功能障碍和嗜睡分别是这些药物治疗失败的首要、第二和第三大主要原因。超过 90%的受访者使用联合治疗而非单一药物治疗严重慢性疼痛，但引用的组合治疗方案不少于 176 种。
疼痛减轻和生活质量改善是最重要的治疗目标。治疗方法的广泛差异表明，没有一种药物特别适合治疗慢性疼痛，这表明目前的治疗方法并非基于证据。组间差异表明一线治疗更为谨慎和传统。本调查的主要局限性包括样本量小、实施不规范以及受访者信息缺乏细节。
