Prescribing of pain medication in palliative care. A survey in general practice.
OBJECTIVE
To examine what pain and adjuvant medication is prescribed in palliative care patients at home in The Netherlands.


METHODS
In a nationwide, representative, prospective study in general practice in The Netherlands, prescribed medication was registered in 95 general practices with a listed population of 374 070 patients. The GPs identified those who received palliative care in a retrospective survey of the 2169 patients who died within the 1-year study period. We analysed the analgesics, laxatives and anti-emetics that were prescribed during the last 3 months of life for these patients.


RESULTS
The response rate of the survey was 74%. 425 patients received palliative care and 73% of them were prescribed pain medication: 55% a non-opioid analgesic (paracetamol, NSAIDs), 21% a weak opioid (tramadol, codeine), and 51% a strong opioid. Relatively more younger than older patients were prescribed strong opioids, and more cancer than non-cancer patients were prescribed an analgesic. During the last 3 months of life, the proportion of patients prescribed a non-opioid or a weak opioid increased gradually. The proportion of patients prescribed a strong opioid increased considerably nearing the patient's death. About one third of the non-cancer patients were prescribed strong opioids, mostly commencing in the last 2 weeks before death. In 48% of all patients with an opioid prescription, the GP did not prescribe a laxative.


CONCLUSIONS
Weak opioids and laxatives are frequently omitted from pain regimens in palliative care at home in The Netherlands.
Borgsteede
Sander D
SD
VU University Medical Center, Department of Public and Occupational Health, EMGO Institute, Amsterdam, The Netherlands. s.borgsteede@vumc.nl
Deliens
Luc
L
Zuurmond
Wouter W A
WW
Schellevis
François G
FG
Willems
Dick L
DL
Van der Wal
Gerrit
G
van Eijk
Jacques Th M
JT
D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D018712:Analgesics, Non-Narcotic / Q000627:therapeutic use*; D000701:Analgesics, Opioid / Q000009:adverse effects / Q000627:therapeutic use*; D000932:Antiemetics / Q000627:therapeutic use; D003625:Data Collection; D005194:Family Practice / Q000379:methods; D005260:Female; D006699:Home Care Services / Q000706:statistics & numerical data; D006801:Humans; D054368:Laxatives / Q000627:therapeutic use; D008297:Male; D009426:Netherlands; D010146:Pain / Q000188:drug therapy* / Q000209:etiology; D010166:Palliative Care / Q000379:methods*; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data; D012189:Retrospective Studies; D013997:Time Factors
D018712:Analgesics, Non-Narcotic; D000701:Analgesics, Opioid; D000932:Antiemetics; D054368:Laxatives