Treatment of non-malignant pain in the dutch GP population: An analysis of treatment standards, prescription habits and basic attitudes

The aim of this study was to evaluate whether dexibuprofen meets the basic requirements of Dutch General Practitioners (GPs) for acceptance as an analgesic in mild to moderate pain. The available GP treatment standards for mild to moderate pain were analysed. If no treatment standard was available, results from two semistructured round table group sessions were used. The available treatment standards are either diagnosis oriented (e.g. otitis media) or symptom oriented (e.g. lower backache). Prescription data (1988-2000) show that GPs usually prescribe the medication suggested by the standards. Paracetamol, diclofenac, ibuprofen and naproxen, all over 25 years old, have a combined marketshare greater than 84%. Most new drugs have been short-lived and/or little prescribed. Round tables show three basic dimensions to pain treatment: objective, subjective, and the action taken to relieve the pain. The objective dimension relates to anamnesis and physical examination to rule out serious causes. The subjective dimension relates to the doctor's assessment of the pain threshold of the patient, expectations towards the doctor, and previous action taken by the patient. The pain relief dimension relates to acceptance of the pain by the patient, the solution proposed by the doctor and the way this is presented. Medication prescribed should be exclusive for doctors. The GP must also have faith in the medication, and so previous experience is a dominant factor in the choice made. GPs are relatively insensitive to new products, as there are few unmet needs. As a new NSAID dexibuprofen meets two basic requirements. First, it is only available to doctors. Secondly, because it is a pure form of ibuprofen, doctors can relate to extensive previous experience when prescribing it. This might ensure its rapid acceptance compared to other new NSAIDs.