Management of cancer pain in Denmark: a nationwide questionnaire survey

A questionnaire survey was carried out with the aim of evaluating knowledge about and practice of cancer pain treatment in Denmark. A questionnaire was sent out to a 10% random sample of Danish physicians. Of these 1411 physicians, 1068 (76%) returned the questionnaires and after exclusion of those doctors who never treated cancer patients, 577 (54%) were analyzed. Their knowledge of the principles and practice of cancer pain treatment was evaluated by means of 14 multiple-choice and open questions. Their ability to apply their knowledge in practice was evaluated by analyzing their suggested treatment of 3 simulated patient cases. The results show that a vast majority (97%) of the physicians were prepared to use opioids conventionally administered for severe pain and that 39% reported the use of other treatment modalities (psychological treatment, antineoplastic therapy, transcutaneous nerve stimulation/acupuncture, etc.). Ninety-seven percent of the physicians recognized difficulties in cancer pain treatment, the most frequent being side effects of drugs and inadequate pain relief. Seventy-five percent considered that their knowledge about pain treatment was fair or better. The overall evaluation of the proposals for pain treatment of the patient cases was primarily based on drug therapy. Adequate doses, correct dose intervals and selection of drugs, routes of administration and other treatments were the requirements for satisfactory answers. It appears that the majority the physicians could treat both pain from bone metastasis (75%) and visceral pain (78%) satisfactorily, while very few suggested co-analgesics for neuropathic pain conditions (20%). Older physicians performed less well than their younger colleagues. Basic pain treatment skills have been acquired by the Danish physicians but, in the future, emphasis should be placed on the treatment of neuropathic pain with co-analgesics and the management of opioid side effects.