Pharmacotherapeutic management of chronic noncancer pain in primary care: lessons for pharmacists.
OBJECTIVE
Describe the pharmacotherapeutic management of primary-care patients with chronic noncancer pain, assess their satisfaction with pain treatment, and identify the determinants of their satisfaction.


METHODS
A cohort study was conducted in Quebec (Canada). Patients reporting chronic noncancer pain with an average pain intensity of at least 4 on a 0-10 scale (10= worst possible pain) and having an active analgesic prescription from a primary-care physician were recruited. They completed a telephone interview and a self-administered questionnaire to document their pain, emotional well-being, satisfaction with treatment, and barriers/beliefs/attitudes about pain and its treatment. Information on pharmacotherapy was based on an administrative provincial database and pharmacies' charts. Determinants of patients' satisfaction were identified using multivariate linear regression models.


RESULTS
Four hundred and eighty six patients participated. Their mean age was 58.4 years and they had had pain for a mean of 11.7 years (standard deviation, ±11.1) at an average pain intensity of 6.5 in the past week. Although 90% reported adverse gastrointestinal effects, 36.4% and 54.4% of these patients took no over-the-counter or prescribed medication for constipation or nausea, respectively. On a scale from 0-100, the mean overall satisfaction score was 64.7 (95% confidence interval [CI] =63.5-65.9). Patient satisfaction was low, particularly regarding the "information about pain and its treatment" (mean 50.6; 95% CI =47.6-53.7) and "treatment efficacy" (mean 53.6; 95% CI =51.5-55.6) subscales. The overall treatment satisfaction score decreased with more pain disability, probable depression and anxiety, more barriers to pain treatment, higher incidence of nausea, and use of over-the-counter analgesics.


CONCLUSIONS
In primary care, patients' level of satisfaction with their pain treatment is not optimal. This study underlines how the expanded scope of practice of community pharmacists may allow them to play a pivotal role in providing information, discussing barriers to pain treatment, and monitoring pain disability, and by appropriately managing pharmacotherapy to optimize effectiveness while minimizing adverse effects.
Faculty of Pharmacy, Université de Montréal, Montreal, Quebec, Canada ; Équipe de recherche en soins de première ligne, Centre de santé et de services sociaux de Laval, Laval, Quebec, Canada ; Centre de recherche du Centre hospitalier de l'Université de Montréal (CRCHUM), Montreal, Quebec, Canada.
Ghaya
G
Jouini
Centre de recherche du Centre hospitalier de l'Université de Montréal (CRCHUM), Montreal, Quebec, Canada ; Department of Anesthesiology, Faculty of Medicine, Université de Montréal, Montreal, Quebec, Canada.
Manon
M
Choinière
Équipe de recherche en soins de première ligne, Centre de santé et de services sociaux de Laval, Laval, Quebec, Canada ; Centre de recherche du Centre hospitalier de l'Université de Montréal (CRCHUM), Montreal, Quebec, Canada.
Elisabeth
E
Martin
Faculty of Pharmacy, Université de Montréal, Montreal, Quebec, Canada ; Sanofi-Aventis Endowment Research Chair in Optimal Drug Use, Université de Montréal, Montreal, Quebec, Canada.
Sylvie
S
Perreault
Équipe de recherche en soins de première ligne, Centre de santé et de services sociaux de Laval, Laval, Quebec, Canada ; Centre de recherche du Centre hospitalier de l'Université de Montréal (CRCHUM), Montreal, Quebec, Canada.
Djamal
D
Berbiche
Institut universitaire de gériatrie de Montréal, Montreal, Quebec, Canada ; Division of Geriatric Medicine and Alan-Edwards Center for Research on Pain, McGill University, Montreal, Quebec, Canada ; Department of Medicine, Faculty of Medicine, Université de Montréal, Montreal, Quebec, Canada.
David
D
Lussier
Équipe de recherche en soins de première ligne, Centre de santé et de services sociaux de Laval, Laval, Quebec, Canada ; Centre de recherche du Centre hospitalier de l'Université de Montréal (CRCHUM), Montreal, Quebec, Canada ; Department of Family Medicine and Emergency, Faculty of Medicine, Université de Montréal, Montreal, Quebec, Canada.
Eveline
E
Hudon
Faculty of Pharmacy, Université de Montréal, Montreal, Quebec, Canada ; Équipe de recherche en soins de première ligne, Centre de santé et de services sociaux de Laval, Laval, Quebec, Canada ; Centre de recherche du Centre hospitalier de l'Université de Montréal (CRCHUM), Montreal, Quebec, Canada ; Sanofi-Aventis Endowment Research Chair in Ambulatory Pharmaceutical Care, Université de Montréal and Centre de santé et de services sociaux de Laval, Quebec, Canada.
Lyne
L
Lalonde
adverse effects; analgesic; cohort study; noncancer chronic pain; pharmacotherapy; primary care