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

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.