Introduction: The WHO analgesic ladder, including the use of strong opioid analgesics for the treatment of cancer pain, is widely accepted. However, the use of opioids for the treatment of non-cancer pain is still controversial. This study investigates doctors' medical knowledge about basic aspects of pain management. Additionally, we determined whether the deficiencies in the treatment of patients suffering from pain are based on the rigorous national narcotic control system in Germany.
Methods: We investigated the juridical and technical knowledge of physicians specializing in pain therapy by a questionnaire. During a postgraduate course the knowledge about pain therapy according to the WHO analgesic ladder and the beliefs concerning the narcotic regulations in Germany were evaluated. The survey participants were asked to rate their attitudes on a 10-point analogue scale (1=disagreement, 10=full agreement). The participants were also asked to indicate occupational criteria such as specialty, clinical practice area, and postgraduate years of practice. Descriptive statistics for the mean values were used.
Results: One hundred and forty-three questionnaires were completed. The majority of participants worked at departments of anaesthesiology. Some 51.1% of the participants had no specific multiple-copy prescriptions for opioid analgesics. Only 72% of the physicians knew from which governmental institution they could order multiple-copy prescriptions. In general, more doctors would prescribe opioids by the use of normal forms. The controlled substance laws were seen as an impediment by the majority of participants, without relevant differences as to their years of practice. The regulations were regarded as ineffective protection against illegal use of opioids. Treatment of pain with strong opioid analgesics was seen as beneficial for the patients. The use of strong opioids for long-term treatment was recommended, and psychological addiction was regarded as non-existent.
Conclusion: Therapy with strong opioids is accepted practice, but significant deficits of legal and technical knowledge uphold the undertreatment of patients suffering from cancer and non-cancer pain. Patients with a legitimate need for pain relief by strong opioids are the unintended victims of tight narcotic regulations and deficits in medical education. An ease of regulatory conditions is mandatory to reduce the reluctance for prescribing opioids. On the other hand intensified continuous medical education is mandatory to reduce the undertreatment of patients with severe pain conditions.