Pharmacotherapeutic management of chronic noncancer pain in primary care: lessons for pharmacists

Figures & data

Figure 1 Recruitment of pharmacies and patients.

Notes: *Pharmacy distribution per region (number of recruited pharmacies/total number per region): Mauricie et Centre du Québec: 6/60 (10%); Montréal: 18/134 (13.4%); Laval: 13/70 (18.5%); Lanaudière: 8/77 (13%); Laurentides: 14/95 (14.7%); Montérégie: 11/77 (14.3%); **patients distribution per region (number of recruited patients per region/total number of patients): Mauricie et Centre du Québec: 44/486 (9%); Montréal: 92/486 (18.9%); Laval: 67/486 (13.8%); Lanaudière: 91/486 (18.7%); Laurentides: 117/486 (24.1%); Montérégie: 75/486 (15.4%).
Abbreviations: n, number; RAMQ, Régie de l’assurance maladie du Québec.

Table 1 Demographic characteristics of patients

Characteristics	n=486 (%)*
Age (years), mean (SD)	58.4 (12.5)
65-years-old and older	145 (29.8)
Under 65 years old	341 (70.2)
Sex, women	329 (67.7)
Mother tongue
French	437 (89.9)
English	24 (4.9)
Highest level of education completed
None or elementary school	132 (27.2)
Secondary school	170 (35.0)
College technical school or university	177 (36.4)
Civil status
Single	64 (13.2)
Married or common-law relationship	263 (54.1)
Separated or divorced	98 (20.2)
Widowed	57 (11.7)
Current work
Full-time job	94 (19.3)
Part-time job	27 (5.6)
Retired	171 (35.2)
Temporary or permanent disability	100 (20.6)
Unemployed	66 (13.6)
Other	28 (5.8)
Annual family income before income tax deduction
<$20,000	128 (26.3)
$20,000–$50,000	188 (38.7)
>$50,000	117 (24.1)
Main source of income
Employment wages or salary	155 (31.9)
Retirement pension	151 (31.1)
Disability benefits	86 (17.7)
Social assistance	39 (8.0)
Personal savings or family member	55 (11.3)

Notes:

* Unless otherwise indicated. Currency is Canadian dollars (CAD).

Abbreviations: n, number; SD, standard deviation.

Table 2 Biopsychosocial characteristics of patients

Characteristics	n=486 (%)*
Pain duration (years),** mean (SD)	11.7 (11.1)
Frequency of pain in the past 7 days
Always	363 (74.7)
Occasionally	116 (23.9)
Never	4 (0.8)
Average pain intensity in the past 7 days,‡ mean (SD)	6.5 (1.9)
Worst pain intensity in the past 7 days,** mean (SD)	8.1 (1.8)
Current pain intensity,‡ mean (SD)	5.4 (2.5)
Sites of pain as reported by patients§
Legs, thighs, knees	314 (64.6)
Back	309 (63.6)
Shoulders and/or arms	252 (51.9)
Head and/or neck	209 (43.0)
Chest and/or abdomen	134 (27.6)
Hips	114 (23.5)
Pain diagnoses as reported by patients§
Osteoarthritis and other osteopathologies	337 (69.3)
Chronic back pain	292 (60.1)
Chronic neck pain	185 (38.1)
Fibromyalgia	114 (23.5)
Tendinitis, bursitis, capsulitis, epicondylitis	98 (20.2)
Neuropathic pain‖	85 (17.5)
Pain related interference (BPI), mean (SD)	5.3 (2.2)
Pain sleep impact (CPSI), mean (SD)	5.1 (2.9)
Level of depression (HADS)
Absent	254 (52.3)
Uncertain	115 (23.7)
Probable	116 (23.9)
Level of anxiety (HADS)
Absent	176 (36.2)
Uncertain	115 (23.7)
Probable	194 (39.9)
Barriers, prejudices and beliefs of patients (BQ-II), mean (SD)	2.6 (0.7)
Physiological effects, mean (SD)	2.5 (0.8)
Fatalism, mean (SD)	3.0 (1.2)
Communication, mean (SD)	2.2 (1.2)
Harmful effects, mean (SD)	3.1 (1.3)
Pain Treatment Satisfaction Scale (PTSS), mean (95% CI)	64.7 (63.5–65.9)
Satisfaction with current pain medication	62.5 (60.8–64.1)
Medication characteristics subscale	71.3 (69.5–73.0)
Efficacy subscale	53.6 (51.5–55.6)
Medical care	67.9 (66.3–69.5)
Impact of current pain medication	58.0 (55.9–60.0)
Information about pain and its treatment	50.6 (47.6–53.7)
Side effects of medication	74.0 (72.4–75.6)

Notes:

* Unless otherwise indicated;

** data missing for three patients;

‡ data missing for four patients;

§ patient may report more than one site of pain;

‖ neuropathic pain includes diabetic neuropathies, postherpetic neuralgia, and traumatic neuropathies.

Abbreviations: BPI, modified Brief Pain Inventory; BQ-II, Barriers Questionnaire II; CI, confidence interval; CPSI, Chronic Pain Sleep Inventory; HADS, Hospital Anxiety and Depression Scale; n, number; PTSS, Pain Treatment Satisfaction Scale; SD, standard deviation.

Table 3 Pharmacotherapy in the past year

	n=486 (%)*
Type of analgesic prescribers**
Primary-care physician	486 (100.0)
Specialist	193 (39.7)
Orthopedic surgeon	35 (7.2)
Neurologist or neurosurgeon	32 (6.6)
Psychiatrist	29 (6.0)
Rheumatologist	28 (5.8)
Specialist in physical medicine and rehabilitation	20 (4.1)
Anaesthesiologist	13 (2.7)
Number of primary-care physicians analgesics prescribers per patient
1 primary-care physician	229 (47.1)
2 primary-care physicians	146 (30.0)
3 or more primary-care physicians	111 (22.8)
Number of pharmacy visits to acquire analgesics, mean (SD)	22.4 (26.1)
Number of dispensed analgesics, mean (SD)	4.2 (2.2)
1–2 analgesics	118 (24.3)
3–5 analgesics	255 (52.5)
6 or more analgesics	113 (23.3)
Prevalence by class of analgesic dispensed**
Nonsteroidal anti-inflammatory drugs	350 (72.0)
Opioids	319 (65.6)
Anticonvulsants	295 (60.7)
Antidepressants	242 (49.8)
Acetaminophen	138 (28.4)
Muscle relaxants	126 (25.9)
Prevalence of use of OTC analgesics‡,§	197 (40.8)
Prevalence of most often used OTC analgesics‡
Acetaminophen	119 (24.5)
Ibuprofen	43 (8.8)
Glucosamine	32 (6.6)
Collagen	17 (3.5)
Prevalence of constipation
Not experienced	124 (25.5)
Mild	138 (28.4)
Moderate to severe	220 (45.3)
Prevalence of nausea and vomiting
Not experienced	219 (45.1)
Mild	170 (35.0)
Moderate to severe	93 (19.1)
Prevalence of heartburn and stomach aches
Not experienced	165 (34.0)
Mild	156 (32.1)
Moderate to severe	164 (33.7)

Notes:

* Unless otherwise indicated;

** more than one answer possible;

‡ prevalence for past 6 months;

§ data missing for three patients.

Abbreviations: n, number; OTC, over-the-counter; SD, standard deviation.

Table 4 Clinical, psychosocial, medical care and pharmacotherapeutic characteristics associated with pain treatment satisfaction

	Pain Treatment Satisfaction Scale
	Beta coefficients in multivariate linear models
	Overall satisfaction	Satisfaction with current pain medication	Medication characteristic subscale	Efficacy subscale	Medical care	Impact of current pain medication	Information about pain and its treatment	Side effects of medication
Intercept	88.0	79.7	75.6	86.7	84.8	80.5	88.7	97.9
Clinical characteristics
Duration of pain
Each additional year of pain			0.23*			0.40**
Frequency of pain
Continuous		−5.6*	−8.2*			−8.0*
Occasional		Reference	Reference			Reference
Number of pain sites
Each additional site			−1.5*			−1.5*
Psychological characteristics
Pain disability (BPI)
Each additional point (0–10 scale)	−1.2**	−1.2*	−1.6*				−1.8*	−1.0**
Pain sleep impact (CPSI)
Each additional point (0–10 scale)						−1.0*
Level of depression (HADS)
Probable	−4.4*					−15.9**
Other	Reference					Reference
Level of anxiety (HADS)
Probable	−4.4*	−4.9*		−6.2*	−5.0*	−5.7*		−4.1
Other	Reference	Reference		Reference	Reference	Reference		Reference
Barriers to pain treatment (BQ-II)
Each addition point (0–5 scale)	−4.3**			−4.4*	−4.2*		−10.1**	−2.0
Pharmacotherapy characteristics
Use of OTC analgesics
Yes	−4.9**	−5.3*	−5.4*		−5.6*	−5.5*
No	Reference	Reference	Reference		Reference	Reference
Moderate to severe constipation
Yes								−9.7**
No								Reference
Moderate to severe heartburn
Yes								−13.5**
No								Reference
Moderate to severe nausea
Yes	−9.2**	−6.8*	−7.1*	−7.4*		−7.6*	−10.3	−15.3**
No	Reference	Reference	Reference	Reference		Reference	Reference	Reference
R^2 of a multiple regression model	0.33	0.13	0.13	0.10	0.08	0.31	0.09	0.62

Notes:

* α P<0.05;

** β P<0.000l.

Abbreviations: BPI, Brief Pain Inventory; BQ-II, Barriers Questionnaire II; CPSI, Chronic Pain Sleep Inventory; HADS, Hospital Anxiety and Depression Scale; OTC, over-the-counter.