Consensus and contention in the treatment of chronic nerve-damage pain

A postal questionnaire survey was carried out to investigate beliefs in the efficacy of specific treatments held by consultants involved in the treatment of chronic nerve-damage pain. One hundred eighty-eight consultants experienced in the treatment of chronic pain were identified by local Pain Clinic consultants in 5 centres. The specialties represented were neurology, neurosurgery, orthopaedic surgery, oncology/radiotherapy, plastic surgery and anaesthesia. Replies were received from 181 consultants (96%). Over one fifth of the consultants expressed no opinion about half of the treatments assessed. Widely divergent views were held by those who did give an opinion. Many clinicians assessed some treatments as 'poor' while other clinicians assessed the same treatments as 'excellent' (neurolytic nerve block, somatic nerve block, cordotomy and opioids). For some treatments divergence of opinion can be explained in part by differences between specialties. For other treatments marked diversity was seen within as well as between specialties. There is a clear need for education in the use of particular treatments, even amongst those clinicians who regularly see this type of patient.