title: GPs prescribing of strong opioid drugs for patients with chronic non-cancer pain: a qualitative study.
abstract: BACKGROUND
  Chronic non-cancer pain (CNCP) is common in the UK. GPs manage most patients with such pain. Previous research has suggested that prescribing is influenced by patient and doctor factors, but less is known about the decision- making process involved in prescribing opioid drugs for CNCP.
  
  
  OBJECTIVE
  To describe the factors influencing GPs' prescribing of strong opioid drugs for CNCP. Design and setting Semi-structured interviews and a focus group of a purposive sample of GPs from a range of practice settings including male and female GPs with experience of prescribing strong opioids.
  
  
  METHODS
  Transcripts of interviews and a focus group were analysed using qualitative research methodology (thematic analysis).
  
  
  RESULTS
  GPs described prescribing opioid drugs for patients with CNCP as being different from treating cancer related pain. GPs followed accepted stepwise approaches in their prescribing for CNCP. They reported difficulty in assessing the level of pain and concern over duration of use of strong opioids and their possible side effects, tolerance, and addiction. Variation in reported practice was observed, which may be linked to experience and significant events.
  
  
  CONCLUSIONS
  GPs in this study demonstrated a thoughtful attitude towards prescribing strong opioids for CNCP. They were aware of the difficulties of long-term strong opioid prescription. Only a few GPs had had specific training in chronic pain management and this may explain some of the variation in practice reported. GPs may benefit from training in pain assessment and long-term management of patients with CNCP.
authors.affiliation: Honiton Research Practice, Honiton, Devon, UK.
authors.forename: David
authors.initials: D
authors.lastname: Seamark
authors.affiliation: Honiton Research Practice, Honiton, Devon, UK.
authors.forename: Clare
authors.initials: C
authors.lastname: Seamark
authors.affiliation: University of Exeter medical School (Primary Care), Exeter, UK.
authors.forename: Colin
authors.initials: C
authors.lastname: Greaves
authors.affiliation: Honiton Research Practice, Honiton, Devon, UK.
authors.forename: Susan
authors.initials: S
authors.lastname: Blake
mesh_terms: D000701:Analgesics, Opioid / Q000191:economics / Q000627:therapeutic use*; D001291:Attitude of Health Personnel; D059350:Chronic Pain / Q000191:economics / Q000517:prevention & control*; D016527:Drug Costs; D005260:Female; D058006:General Practice / Q000191:economics / Q000379:methods*; D058005:General Practitioners / Q000191:economics / Q000523:psychology; D006801:Humans; D008297:Male; D009293:Opioid-Related Disorders / Q000191:economics / Q000517:prevention & control; D010147:Pain Measurement; D010166:Palliative Care / Q000191:economics / Q000379:methods; D010818:Practice Patterns, Physicians'
chemical_list: D000701:Analgesics, Opioid