Chronic pain management by Swiss specialist physicians with the primary hypothesis that pain clinic practitioners conform better to good practice (interdisciplinarity, diagnostic/therapeutic routines, quality control, education) than other specialists treating
chronic pain was surveyed. Management of all types of
chronic pain by pain clinic practitioners and rheumatologists, oncologists or neurologists was compared via a mailed questionnaire survey (n=125/group). Two hundred and twenty-nine (46%) of 500 mailed questionnaires were returned with similar group return rates. Eighty-six percent of responders find
chronic pain therapy very difficult/difficult; they estimate only 45% of these patients achieve good outcomes. Twenty-three per cent of responders belong to an interdisciplinary
pain centre, but 72% of
chronic pain patients are treated by responders alone. Fifty-nine percent never/only occasionally
use therapeutic algorithms, 38% use formal
pain diagnostic procedures, 20% have a
pain quality control programme. Fifty-one percent lack past
pain education, 37% do not attend continuing
pain education, 69% agree that
pain education is their greatest need. Pain clinic practitioners are more interdisciplinary and use more
pain diagnostics than other specialists. They are matched by oncologists in education and success in therapeutic escalation, and bettered by them in algorithm use. Pain clinic practitioners and oncologists bring particular-differing-skills to
chronic pain management compared to rheumatologists and neurologists.
Chronic pain management diversity may result from differences in malignant and benign
pain, and its generally being provided by the speciality treating the underlying cause. This survey identifies targets for improvement in areas fundamental to good
chronic pain practice: interdisciplinarity, diagnostic/therapeutic tools, quality management and education.