Family physicians' experience with chronic non-cancer pain in the Community of Madrid
Journal: Advances in Medicine and Engineering Interdisciplinary Research DOI: 10.32629/ameir.v4i2.5259
Abstract
Aims: to explore the beliefs and management of patients with chronic non-cancer pain (CNCP) among primary care physicians in the public health system of the Community of Madrid. Methods: this was an observational, descriptive, cross-sectional study, performed by means of an anonymous 23-item questionnaire that was distributed electronically to 1148 professionals. Results: the response rate was 6.4%. Of respondents, 59.4% believe that paracetamol is of limited effectiveness; 27.3% think that topical NSAIDs are a first-line treatment for gonarthrosis and small joints; 62.8% consider opioids effective, and 50% consider them safe. However, 72.8% believe that an approach based on education and physical
exercise is more effective than pharmacological treatment, providing advice on these approaches in 77.2% and 99.4% of cases, respectively. Conclusions: the results highlight the need for CNCP training focused on education and physical exercise, as well as recognition of the limited evidence for certain pharmacological treatments.
Keywords
analgesics; chronic pain; education; exercise; opioid
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[4] Instituto Nacional de Estadística. Encuesta Europea de Salud en España (EESE) 2020. [Internet]. Madrid: Ministerio de Sanidad, Gobierno de España; 2020 [citado 10 mar 10]. Disponible en: https://www.sanidad.gob.es/estadEstudios/estadisticas/EncuestaEuropea/EncuestaEuropea2020/EESE2020_inf_evol_princip_result.pdf.
[5] Sánchez Jiménez J, Tejedor Varillas A, Carrascal Garrido R. La atención al paciente con dolor crónico no oncológico en Atención Primaria. Documento de Consenso. [Internet]. 2016 [citado 10 mar 2025]. Disponible en: https://www.semfyc.es/wp-content/uploads/2016/06/DOCUMENTO-CONSENSO-DOLOR-17-04-A.pdf.
[6] National Institute for Health and Care Excellence. Chronic pain (primary and secondary) in over 16s: assessment of all chronic pain and management of chronic primary pain [Internet]. Guía NICE n.º 193. 2021 [citado 13 mar 2025]. Disponible en: https://www.nice.org.uk/guidance/ng143.
[7] Ministerio de Sanidad, Gobierno de España. Encuesta sobre alcohol y otras drogas en España (EDADES) 2022 [Internet]. 2023 [citado 13 mar 2025]. Disponible en:
https://pnsd.sanidad.gob.es/profesionales/sistemasInformacion/sistemaInformacion/pdf/2022_Informe_EDADES.pdf
[8] Kolasinski SL, Neogi T, Hochberg MC, Oatis C, Guyatt G, Block J, et al. 2019 American College of Rheumatology/Arthritis Foundation guideline for the management of osteoarthritis of the hand, hip, and knee. Arthritis Care Res (Hoboken). 2020 Feb;72(2):149-62. doi:10.1002/acr.24131.
[9] Bannuru RR, Osani MC, Vaysbrot EE, Arden NK, Bennell K, Bierma-Zeinstra SMA, et al. OARSI guidelines for the non-surgical management of knee, hip, and polyarticular osteoarthritis. Osteoarthritis Cartilage. 2019 Nov;27(11):1578-89. doi:10.1016/j.joca. 2019.06.011.
[10] Onakpoya IJ. Paracetamol as first line for treatment of knee and hip osteoarthritis. BMJ Evid Based Med. 2020 Feb;25(1):40. doi:10.1136/bmjebm-2019-111213.
[11] Qaseem A, McLean RM, O'Gurek D, Batur P, Lin K, Kansagara DL, Clinical Guidelines Committee of the American College of Physicians, Commission on Health of the Public and Science of the American Academy of Family Physicians, Cooney TG, Forciea MA, Crandall CJ, Fitterman N, Hicks LA, Horwitch C, et al. Nonpharmacologic and pharmacologic management of acute pain from non-low back, musculoskeletal injuries in adults: a clinical guideline from the American College of Physicians and American Academy of Family Physicians. Ann Intern Med. 2020 Nov;173(9):739-48. doi:10.7326/M19-3602.
[12] Harris E. Opioids no better than placebo at relieving back pain. JAMA. 2023 Ago 1;330(5):401. doi: 10.1001/jama.2023.12536.
[13] Dolor crónico no-oncológico: ¿opioides? [Internet]. INFAC. 2022;30(1):1-10. Disponible en: https://www.euskadi.eus/contenidos/informacion/cevime_infac_2022/es_def/adjuntos/INFAC_Vol_30_1_OPIOIDES-CNCP.pdf.
[14] Allan GM, Basset KL. Gabapentin & Chronic Pain: Missing Evidence and Real Effect? Tools for Practice. Alberta College of Family Physicians. [Internet]. 2010 [citado el 7 de enero de 2025]. Disponible en: https://cfpclearn.ca/tfp25/.
[15] Roche Bueno JC. Eficacia de pregabalina, gabapentina y duloxetina en el dolor neuropático verificado por el análisis de la curva-p. Rev Soc Esp Dolor. 2020;27(1):16-23. doi:10.20986/resed.2020.3727/2019.
[16] Buchbinder R, Underwood M, Hartvigsen J, Maher CG. The Lancet Series call to action to reduce low value care for low back pain: an update. Pain. 2020 Sep;161 Suppl 1(1):S57-S64. doi: 10.1097/j.pain.0000000000001869. PMID: 33090740; PMCID: PMC7434211.
[17] Rufener L, Akre C, Rodondi P-Y, Dubois J. Management of chronic non-cancer pain by primary care physicians: A qualitative study. PLoS One. [Internet]. 2024;19(7):e0307701. doi: 10.1371/journal.pone.0307701.
[18] Dalle G, Aloiso Alves C, Clerc P, Le Breton J. A narrative approach for the management of low back pain in general practice: An in-depth patient interviews study. Eur J Gen Pract [Internet]. 2025;31(1):2522183. doi: 10.1080/13814788.2025.2522183.
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