Brinkmöller Sabrina, Poß-Doering Regina, Balzer Alexandra, Paul Cinara, Wurmbach Viktoria S, Zugaj Marco R, Wensing Michel, Straßner Cornelia
Department of Primary Care and Health Services Research, Heidelberg University, Medical Faculty/Heidelberg University Hospital, Heidelberg, Germany.
Institute of Medical Biometry (IMBI), Heidelberg University, Medical Faculty/Heidelberg University Hospital, Heidelberg, Germany.
Fam Pract. 2025 Jun 4;42(4). doi: 10.1093/fampra/cmaf032.
Prescribing high-potency opioids for chronic non-cancer pain has increased in Germany, despite limited evidence of long-term efficacy. General practitioners write approximately 87% of all opioid prescriptions. The guideline "Long-term use of opioids for chronic non-cancer pain" (LONTS) provides recommendations for responsible opioid management, but its uptake in primary care remains unclear.
This study investigates how general practitioners apply LONTS guideline recommendations and identifies barriers to implementation.
A mixed-methods study was conducted, including an online questionnaire to detect deviations from LONTS recommendations, followed by semi-structured telephone interviews to explore barriers for guideline adherence.
A total of 131 questionnaires and 21 interviews with general practitioners were analyzed. 45% of questionnaire participants were unfamiliar with the LONTS guideline. Four key gaps were identified: (i) Nearly 40% of general practitioners rarely or never set individualized treatment goals for chronic pain patients; (ii) 49% preferred combining long-acting opioids at fixed intervals with short-acting opioids on demand; (iii) 17% used short-acting opioid monotherapy, considered a treatment error; (iv) 44% did not discuss opioid reduction or discontinuation after 6 months of effective pain relief. Qualitative analysis identified key barriers: lack of integration into daily routines, anticipating patients' fear of pain recurrence, and preference for personal experience over evidence.
General practitioners in Germany may struggle to implement LONTS recommendations for opioid use in chronic non-cancer pain. Targeted strategies are needed to promote and improve the adoption of these guidelines in primary care.
尽管长期疗效的证据有限，但德国用于慢性非癌性疼痛的强效阿片类药物处方量仍在增加。全科医生开具了所有阿片类药物处方的约87%。“慢性非癌性疼痛的阿片类药物长期使用”（LONTS）指南为负责任的阿片类药物管理提供了建议，但其在初级保健中的采用情况仍不明确。
本研究调查全科医生如何应用LONTS指南建议，并确定实施障碍。
进行了一项混合方法研究，包括一份在线问卷以检测与LONTS建议的偏差，随后进行半结构化电话访谈以探讨遵循指南的障碍。
共分析了131份问卷和与全科医生的21次访谈。45%的问卷参与者不熟悉LONTS指南。确定了四个关键差距：（i）近40%的全科医生很少或从未为慢性疼痛患者设定个体化治疗目标；（ii）49%的人更喜欢定期联合使用长效阿片类药物和按需使用短效阿片类药物；（iii）17%的人使用短效阿片类药物单一疗法，这被视为治疗错误；（iv）44%的人在有效缓解疼痛6个月后未讨论阿片类药物的减量或停药。定性分析确定了关键障碍：缺乏融入日常工作、预期患者对疼痛复发的恐惧以及更倾向于个人经验而非证据。
德国的全科医生在实施LONTS关于慢性非癌性疼痛中阿片类药物使用的建议时可能会遇到困难。需要有针对性的策略来促进和改善这些指南在初级保健中的采用。
