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  • Primary Health Care Research & Development, Volume 9, Issue 2
  • April 2008, pp. 146-156

Patterns of prescription and concern about opioid analgesics for chronic non-malignant pain in general practice

  • Lance M. McCracken (a1), Sophie C. Velleman (a1) and Christopher Eccleston (a1)
  • DOI:
  • Published online: 01 April 2008

The purpose of this study was to investigate the circumstances of opioid prescription among general practitioners (GPs) in the UK.


Prescription of opioids for chronic pain, particularly non-malignant chronic pain, remains controversial. In the midst of this controversy, patterns of actual prescription and influences on these patterns are not well understood.


A mail survey was posted to 1192 GPs and it was returned by 414 (35.0%). The survey addressed the frequency and reluctance in GP prescription of opioids for chronic pain. It also sampled their attitudes and concerns about opioids, including their views on appropriateness and effectiveness, adverse effects and potential social pressures presumed to impact on prescribing.


Overall, 57.9% of GPs reported they sometimes, frequently, or always, prescribe strong opioids for chronic pain, which was of significantly lower frequency than for prescribing of weak opioids, non-steroidal anti-inflammatory drugs (NSAIDs) or tricyclic antidepressant medications. Similarly, 69.1% reported a reluctance to prescribe strong opioids for chronic non-malignant pain, which was a significantly greater reluctance than for cancer pain, for example. GPs who were men, younger, had fewer years experience and worked full time (as opposed to part time), were more likely to prescribe opioids. Practice guideline use was unrelated to prescribing but those with specialty training were more likely to prescribe. Interestingly, a majority of GPs (83.0%) felt that opioids are effective for chronic non-malignant pain; however, they worry about long-term commitment (such as managing dosing and repeat prescriptions), addiction and other adverse events.


Based on multivariate analyses, both frequency of prescribing and reluctance were predicted by a combination of concerns about effects on patient behaviour, professional competency concerns and degree of belief in opioids as an effective option. These results may suggest a need for additional GP training in the management of analgesics for chronic non-malignant pain.

Corresponding author
Pain Management Unit, Royal National Hospital for Rheumatic Diseases, Bath BA1 1RL, UK. Email:
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This list contains references from the content that can be linked to their source. For a full set of references and notes please see the PDF or HTML where available.

H. Breivik , B. Collett , V. Ventafridda , R. Cohen D. Gallacher 2006: Survey of pain in Europe: prevalence, impact on daily life, and treatment. European Journal of Pain 10, 287333.

D. Cherkin , R.A. Deyo , A.O. Berg , J.J. Bergman D.M. Lishner 1991a: Evaluation of a physician education intervention to improve primary care for low-back pain I: impact on physicians. Spine 16, 11681172.

A.M. Elliot , B.H. Smith , K.I. Penny , W.C. Smith W.A. Chambers 1999: The epidemiology of chronic pain in the community. Lancet 354, 12481252.

A.M. Elliot , B.H. Smith , P.C. Hannafor , W.C. Smith W.A. Chambers 2002: The course of chronic pain in the community: results of a 4-year follow-up study. Pain 99, 299307.

J. Eriksen , P. Sjogren , E. Bruera , O. Ekholm N.K. Rasmussen 2006: Critical issues on opioids in chronic non-cancer pain: an epidemiological study. Pain 125, 172179.

O. Gureje , G.E. Simon M. Von Korff 2001: A cross-national study of the course of persistent pain in primary care. Pain 92, 195200.

K. Hutchinson , A.M.E Moreland , A.C.deC. Williams , J. Weinman R. Horne 2007: Exploring beliefs and practice of opioids prescribing for persistent non-cancer pain by general practitioners. European Journal of Pain 11, 9398.

E. Kalso , J.E. Edwards , R.A. Moore H.J. McQuay 2004: Opioids in chronic non-cancer pain: systematic review of efficacy and safety. Pain 112, 372380.

N. Maniadakis A. Gray 2000: The economic burden of back pain in the UK. Pain 84, 95103.

L.M. McCracken , J. Hoskins C. Eccleston 2006: Concerns about medication and medication use in chronic pain. Journal of Pain 7, 726734.

M. Panda , N. Desbiens , N. Doshi S. Sheldon 2004: Determinants of prescribing meperidine compared to morphine in hospitalised patients. Pain 110, 337342.

R.P. Sequeira , A.l. Jassim , K.A. Khaja , A.H.H. Damanhouri V.S. Mathur 2003: Physician gender and antihypertensive prescription pattern in primary care. Journal of Evaluation in Clinical Practice 9, 409415.

T.A. Sheldon , C. Cullum , D. Dawson , A. Lankshear , K. Lowson , I. Watt , P. West , D. Wright J. Wright 2004: What’s the evidence that NICE guidance has been implemented? Results from a national evaluation using times series analysis, audit of patients’ notes, and interviews. British Medical Journal 329, 9991006.

B.H. Smith , A.M. Elliott , P.C. Hannaford , W.A. Chambers W.C. Smith 2004: Factors related to the onset and persistence of chronic back pain in the community: results from a general population follow-up study. Spine 29, 10321040.

C. Stannard M. Johnson 2003: Chronic pain management – can we do better? An interview-based survey in primary care. Current Medical Research and Opinion 19, 703706.

C.C. Upshur , R.S. Luckman J.A. Savageau 2006: Primary care provider concerns about management of chronic pain in community clinic population. Journal of General Internal Medicine 21, 652655.

A.D. Woolf , H. Zeidler , U. Haglund , A.J. Carr , S. Chaussade , D. Cucinotta , D.J. Veale E. Martin-Mola 2004: Musculoskeletal pain in Europe: its impact and a comparison of population and medical perceptions of treatment in eight European countries. Annals of Rheumatic Disease 63, 342347.

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Primary Health Care Research & Development
  • ISSN: 1463-4236
  • EISSN: 1477-1128
  • URL: /core/journals/primary-health-care-research-and-development
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