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N+R_CP_vol4

6 References 1. Miller FG and Kaptchuk TJ. The power of context: reconceptualizing the pla- cebo effect. J R Soc Med 2008;101:222–25. 2. Price DD, Finniss DG, Bene- detti F. A comprehensive re- view of the placebo effect: recent advances and current thought. Annu Rev Psychol 2008;59:565–90. 3. Tracey I. Getting the pain you expect: mechanisms of placebo, nocebo and reapp- raisal effects in humans. Nat Med 2010;16(11):1277–83. the lower the proportion of patients who were satisfied with their cur- rent treatment. Patients visiting a pain specialist had a higher level of satisfaction with their treatment than those vi- siting a GP or orthopaedic specia- list. As before, the most common reason for dissatisfaction with treat- ment was inadequate pain relief. Prescribing habits were found to vary according to specialisation. Pain specialists were more likely to prescribe strong opioids as mo- notherapy or in combination with other drugs compared to GPs or orthopedic specialists who ten- ded to prescribe more NSAIDs/ non-opioids. For all specialisations, NSAIDs/non-opioids combined with weak opioids were the most frequent choice. This was followed by NSAIDs/non-opioids with strong opioids for pain spe- cialists and GPs and NSAIDs/non-opioids used with a range of other drugs or in combination with non-medical treat- ment for orthopedic specialists. Patient satisfaction The more intense the pain, the hig- her the level of pain patients find acceptable under a successful pain therapy; this ranged from an NRS value of 1.4 in patients with mild pain to 2.9 in those with unbearable pain. Almost all patients reported that their current pain level was higher than what they would tole- rate under successful therapy. This result was the same in all specialty groups. Overall 30% of responders said they were dissatisfied with their current treatment, with those with the most severe pain showing the highest dissatisfaction. In most cases (84%), insufficient pain relief was cited as a reason, but more than a quarter (29%) cited side ef- fects such as fatigue, sweating and gastrointestinal problems. SUFFICIENCY OF PAIN TREATMENT About half the patient population reported a medium to high need for improvement in their ability to work, sleep and carry out general activities. In all three situations this need increased proportionally with higher pain intensities. Treatment variation by speciali- sation Further analysis was carried out to determine any variation between patients being treated for chronic pain by GPs, pain specialists or or- thopedic specialists. More patients suffered from severe or unbearable pain in the pain specialist and ortho- pedic specialist groups than the GP group. As in the main survey, the level of pain considered acceptable was proportional to the severity of pain experienced. For each specia- lisation, the more severe the pain, GPs (n=3312) Pain Specialists (n=1874) Orthopedists (n=749) Satisfied with current pain treatment 32% 38% 60% 92% 4% 3% 23% 42% 27% 5% 1% 34% 42% 17% Satisfied with current pain treatment 51% 70% 82% 95% 5% 2% 32% 46% 15% Satisfied with current pain treatment 47% 49% 76% 90% Patient satisfaction with current pain treatment (specialities differences) Extreme pain Severe pain Moderate pain Mild pain No pain The severity of pain was consistently inversely proportional to their satisfaction with current pain management (European Survey of Chronic Pain Patients: Results for Germany, submitted)

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