Abstract
Chronic non-malignant pain (CNMP) is commonly managed by General Practitioners (GPs) in primary care. Analgesics are the mainstay of CNMP management in this setting. Selection of medications by GPs may be influenced by micro factors which are relevant to the practice setting, meso factors which relate to the local or regional environment or macro factors such as those arising from national or international influences. The aim of this study is to explore influences on GP practises in relation to pain management for older adults with CNMP. Semi-structured interviews were conducted with 12 GPs. Transcripts were organised using the Framework Method of Data Management while an applied thematic analysis was used to identify the themes emerging from the data. Clinical considerations such as the efficacy of analgesics, adverse effects and co-morbidities strongly influence prescribing decisions. The GPs interviewed identified the lack of guidance on this subject in Ireland and described the impact of organisational and structural barriers of the Irish healthcare system on the management of CNMP. Changes in practice behaviours coupled with health system reforms are required to improve the quality and consistency of pharmacotherapeutic management of CNMP in primary care.
Highlights
Chronic non-malignant pain (CNMP), has been defined as pain that persists for at least three months [1]
This study deepens our understanding of this subject and enhances our knowledge of how micro, meso and macro factors relate to the prescribing of analgesics for older patients with CNMP
The Irish healthcare system differs substantially in its structures and operation from other European countries, it was the micro factors relating to the patient that appeared to most influence General Practitioners (GPs)
Summary
Chronic non-malignant pain (CNMP), has been defined as pain that persists for at least three months [1]. CNMP is a highly prevalent condition, estimated to affect 12%–30% of the European population with an increased prevalence observed in elderly populations [2,3,4]. This increased burden of CNMP among the elderly has been attributed to the development and progression of chronic degenerative conditions associated with the ageing process [5]. Physiological alterations associated with the ageing process including multiple morbidities, cognitive decline and polypharmacy may limit the types of analgesics a clinician may use for pain management in older
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