Prescribing of pain medication in palliative care. A survey in general practice†
Article first published online: 4 NOV 2008
Copyright © 2008 John Wiley & Sons, Ltd.
Pharmacoepidemiology and Drug Safety
Volume 18, Issue 1, pages 16–23, January 2009
How to Cite
Borgsteede, S. D., Deliens, L., Zuurmond, W. W. A., Schellevis, F. G., Willems, D. L., Van der Wal, G. and van Eijk, J. Th. M. (2009), Prescribing of pain medication in palliative care. A survey in general practice. Pharmacoepidem. Drug Safe., 18: 16–23. doi: 10.1002/pds.1678
No conflict of interest was declared.
- Issue published online: 29 DEC 2008
- Article first published online: 4 NOV 2008
- Manuscript Accepted: 2 OCT 2008
- Manuscript Revised: 22 SEP 2008
- Manuscript Received: 9 NOV 2007
- drug prescribing;
- general practice;
- pain management;
- palliative care;
To examine what pain and adjuvant medication is prescribed in palliative care patients at home in The Netherlands.
In a nationwide, representative, prospective study in general practice in The Netherlands, prescribed medication was registered in 95 general practices with a listed population of 374 070 patients. The GPs identified those who received palliative care in a retrospective survey of the 2169 patients who died within the 1-year study period. We analysed the analgesics, laxatives and anti-emetics that were prescribed during the last 3 months of life for these patients.
The response rate of the survey was 74%. 425 patients received palliative care and 73% of them were prescribed pain medication: 55% a non-opioid analgesic (paracetamol, NSAIDs), 21% a weak opioid (tramadol, codeine), and 51% a strong opioid. Relatively more younger than older patients were prescribed strong opioids, and more cancer than non-cancer patients were prescribed an analgesic. During the last 3 months of life, the proportion of patients prescribed a non-opioid or a weak opioid increased gradually. The proportion of patients prescribed a strong opioid increased considerably nearing the patient's death. About one third of the non-cancer patients were prescribed strong opioids, mostly commencing in the last 2 weeks before death. In 48% of all patients with an opioid prescription, the GP did not prescribe a laxative.
Weak opioids and laxatives are frequently omitted from pain regimens in palliative care at home in The Netherlands. Copyright © 2008 John Wiley & Sons, Ltd.