Drug management of pain caused by cancer: a study of general practitioners' treatment attitudes and practices

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Abstract
This study assesses the treatment attitudes and practices of general practitioners in the management of pain caused by cancer. The study consisted of two parts: (1) a questionnaire survey of 328 GPs (including trainees) in Tayside, Scotland and (2) an analysis using duplicate prescriptions of all opioid analgesic prescribing over a five-year period among the doctors in a primary health care centre (population 11500). In the questionnaire survey, 63% (206) of the GPs replied. Of these respondents, 80% were prepared to manage malignant pain on their own and 17% would refer 'frequently' to the local hospice. Only 19% of respondents work in collaboration with the pain clinic and, if so, the pain clinic undertakes most of the decisions made on pain management. Co-proxamol (paracetamol plus dextropropoxyphene hydrochloride preparation) was the preferred analgesic for mild to moderate pain due to cancer and controlled-release morphine sulphate was preferred for severe pain. Duplicate prescription monitoring showed that 24% (2722) of patients received one or more prescriptions for opioid analgesics over the study period. Forty-five per cent of the patients were prescribed co-proxamol. When morphine sulphate or diamorphine was prescribed (3% and 1 % of patients respectively), laxatives were frequently coprescribed (64% and 58% respectively), as were anti-emetics (57% and 32% respectively). This study therefore shows that most GPs manage pain caused by cancer without help from hospital specialists. This study also shows a degree of awareness concerning good prescribing practice in cancer pain.

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