The management of chronic pain in Switzerland: A comparative survey of Swiss medical specialists treating chronic pain

Chronic pain management by Swiss specialist physicians with the primary hyp othesis that pain clinic practitioners conform better to good practice (int erdisciplinarity, diagnostic/therapeutic routines, quality control, educati on) than other specialists treating chronic pain was surveyed. Management of all types of chronic pain by pain clinic practitioners and rh eumatologists, oncologists or neurologists was compared via a mailed questi onnaire survey (n=125/group). Two hundred and twenty-nine (46%) of 500 mailed questionnaires were returne d with similar group return rates. Eighty-six percent of responders find ch ronic pain therapy very difficult/difficult; they estimate only 45% of thes e patients achieve good outcomes. Twenty-three per cent of responders belon g to an interdisciplinary pain centre, but 72% of chronic pain patients are treated by responders alone. Fifty-nine percent never/only occasionally us e therapeutic algorithms, 38% use formal pain diagnostic procedures, 20% ha ve a pain quality control programme. Fifty-one percent lack past pain educa tion, 37% do not attend continuing pain education, 69% agree that pain educ ation is their greatest need. Pain clinic practitioners are more interdisciplinary and use more pain diag nostics than other specialists. They are matched by oncologists in educatio n and success in therapeutic escalation, and bettered by them in algorithm use. Pain clinic practitioners and oncologists bring particular-differing-s kills to chronic pain management compared to rheumatologists and neurologis ts. Chronic pain management diversity may result from differences in malign ant and benign pain, and its generally being provided by the speciality tre ating the underlying, cause. This survey identifies targets for improvement in areas fundamental to good chronic pain practice: interdisciplinarity, d iagnostic/therapeutic tools, quality management and education. (C) 2001 Eur opean Federation of Chapters of the International Association for the Study of Pain.