Exploring opioid management challenges in chronic non-cancer pain: findings from a mixed-methods study among general practitioners in Germany.

IF 2.4 4区 医学 Q1 MEDICINE, GENERAL & INTERNAL
Sabrina Brinkmöller, Regina Poß-Doering, Alexandra Balzer, Cinara Paul, Viktoria S Wurmbach, Marco R Zugaj, Michel Wensing, Cornelia Straßner
{"title":"Exploring opioid management challenges in chronic non-cancer pain: findings from a mixed-methods study among general practitioners in Germany.","authors":"Sabrina Brinkmöller, Regina Poß-Doering, Alexandra Balzer, Cinara Paul, Viktoria S Wurmbach, Marco R Zugaj, Michel Wensing, Cornelia Straßner","doi":"10.1093/fampra/cmaf032","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Prescribing high-potency opioids for chronic non-cancer pain has increased in Germany, despite limited evidence of long-term efficacy. General practitioners write approximately 87% of all opioid prescriptions. The guideline \"Long-term use of opioids for chronic non-cancer pain\" (LONTS) provides recommendations for responsible opioid management, but its uptake in primary care remains unclear.</p><p><strong>Objective: </strong>This study investigates how general practitioners apply LONTS guideline recommendations and identifies barriers to implementation.</p><p><strong>Methods: </strong>A mixed-methods study was conducted, including an online questionnaire to detect deviations from LONTS recommendations, followed by semi-structured telephone interviews to explore barriers for guideline adherence.</p><p><strong>Results: </strong>A total of 131 questionnaires and 21 interviews with general practitioners were analyzed. 45% of questionnaire participants were unfamiliar with the LONTS guideline. Four key gaps were identified: (i) Nearly 40% of general practitioners rarely or never set individualized treatment goals for chronic pain patients; (ii) 49% preferred combining long-acting opioids at fixed intervals with short-acting opioids on demand; (iii) 17% used short-acting opioid monotherapy, considered a treatment error; (iv) 44% did not discuss opioid reduction or discontinuation after 6 months of effective pain relief. Qualitative analysis identified key barriers: lack of integration into daily routines, anticipating patients' fear of pain recurrence, and preference for personal experience over evidence.</p><p><strong>Conclusion: </strong>General practitioners in Germany may struggle to implement LONTS recommendations for opioid use in chronic non-cancer pain. Targeted strategies are needed to promote and improve the adoption of these guidelines in primary care.</p>","PeriodicalId":12209,"journal":{"name":"Family practice","volume":"42 4","pages":""},"PeriodicalIF":2.4000,"publicationDate":"2025-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12235002/pdf/","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Family practice","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1093/fampra/cmaf032","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"MEDICINE, GENERAL & INTERNAL","Score":null,"Total":0}
引用次数: 0

Abstract

Background: Prescribing high-potency opioids for chronic non-cancer pain has increased in Germany, despite limited evidence of long-term efficacy. General practitioners write approximately 87% of all opioid prescriptions. The guideline "Long-term use of opioids for chronic non-cancer pain" (LONTS) provides recommendations for responsible opioid management, but its uptake in primary care remains unclear.

Objective: This study investigates how general practitioners apply LONTS guideline recommendations and identifies barriers to implementation.

Methods: A mixed-methods study was conducted, including an online questionnaire to detect deviations from LONTS recommendations, followed by semi-structured telephone interviews to explore barriers for guideline adherence.

Results: A total of 131 questionnaires and 21 interviews with general practitioners were analyzed. 45% of questionnaire participants were unfamiliar with the LONTS guideline. Four key gaps were identified: (i) Nearly 40% of general practitioners rarely or never set individualized treatment goals for chronic pain patients; (ii) 49% preferred combining long-acting opioids at fixed intervals with short-acting opioids on demand; (iii) 17% used short-acting opioid monotherapy, considered a treatment error; (iv) 44% did not discuss opioid reduction or discontinuation after 6 months of effective pain relief. Qualitative analysis identified key barriers: lack of integration into daily routines, anticipating patients' fear of pain recurrence, and preference for personal experience over evidence.

Conclusion: General practitioners in Germany may struggle to implement LONTS recommendations for opioid use in chronic non-cancer pain. Targeted strategies are needed to promote and improve the adoption of these guidelines in primary care.

探索阿片类药物管理在慢性非癌性疼痛中的挑战:来自德国全科医生的混合方法研究结果。
背景:在德国,处方高效阿片类药物治疗慢性非癌性疼痛的情况有所增加,尽管长期疗效的证据有限。大约87%的阿片类药物处方是全科医生开的。指南“长期使用阿片类药物治疗慢性非癌性疼痛”(LONTS)为负责任的阿片类药物管理提供了建议,但其在初级保健中的应用仍不清楚。目的:本研究调查全科医生如何应用LONTS指南建议并确定实施的障碍。方法:进行了一项混合方法的研究,包括一份在线问卷来检测与LONTS建议的偏差,然后是半结构化的电话访谈来探索指南遵守的障碍。结果:共对131份问卷和21份全科医生访谈进行分析。45%的问卷参与者不熟悉LONTS指南。发现了四个关键差距:(i)近40%的全科医生很少或从未为慢性疼痛患者设定个性化治疗目标;(ii) 49%的人倾向于按需结合长效阿片类药物和短效阿片类药物;(iii) 17%使用短效阿片类药物单一疗法,被认为是治疗错误;44%的患者在6个月有效缓解疼痛后没有讨论阿片类药物的减少或停药。定性分析确定了主要障碍:缺乏融入日常生活,预测患者对疼痛复发的恐惧,以及对个人经验的偏好高于证据。结论:德国的全科医生可能难以实施LONTS建议的阿片类药物在慢性非癌性疼痛中的使用。需要有针对性的战略来促进和改进这些准则在初级保健中的采用。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
求助全文
约1分钟内获得全文 求助全文
来源期刊
Family practice
Family practice 医学-医学:内科
CiteScore
4.30
自引率
9.10%
发文量
144
审稿时长
4-8 weeks
期刊介绍: Family Practice is an international journal aimed at practitioners, teachers, and researchers in the fields of family medicine, general practice, and primary care in both developed and developing countries. Family Practice offers its readership an international view of the problems and preoccupations in the field, while providing a medium of instruction and exploration. The journal''s range and content covers such areas as health care delivery, epidemiology, public health, and clinical case studies. The journal aims to be interdisciplinary and contributions from other disciplines of medicine and social science are always welcomed.
×
引用
GB/T 7714-2015
复制
MLA
复制
APA
复制
导出至
BibTeX EndNote RefMan NoteFirst NoteExpress
×
提示
您的信息不完整,为了账户安全,请先补充。
现在去补充
×
提示
您因"违规操作"
具体请查看互助需知
我知道了
×
提示
确定
请完成安全验证×
copy
已复制链接
快去分享给好友吧!
我知道了
右上角分享
点击右上角分享
0
联系我们:info@booksci.cn Book学术提供免费学术资源搜索服务,方便国内外学者检索中英文文献。致力于提供最便捷和优质的服务体验。 Copyright © 2023 布克学术 All rights reserved.
京ICP备2023020795号-1
ghs 京公网安备 11010802042870号
Book学术文献互助
Book学术文献互助群
群 号:604180095
Book学术官方微信