Survey of the prescription of step-2 analgesics in persons aged 75 years and older in general practitioners

Objectives. Although step-2 analgesics (S2A) are recommended when step-1 analgesics (S1A) are ineffective or in cases of moderate to severe pain, their efficacy varies. This study evaluated the place attributed by general practitioners (GPs) to S2A in the treatment of nociceptive pain in elderly persons (EP). Method. Descriptive, transversal and declarative study conducted among GPs in Burgundy. Results. In total, 115 GPs took part in the survey. Among these, 60.8% had at least one consultation/day for pain. After paracetamol, which was systematically preferred, 56.4% prescribed S2A for EP. The reasons for prescribing S2A included pain not relieved by S1A in 93% of cases, another medical treatment or not (42.6%), or the existence of moderate to severe pain (31.3%). The use of S2A was more frequent in acute pain (79.1%) than in chronic pain (53%). Among GPs, 77.4% initially prescribed the minimal effective dose. GPs were reluctant to prescribe S2As for the following reasons: poor tolerance (78.3%) and the fear of severe adverse effects (57.4%). The most frequently cited adverse effects were nausea/vomiting and constipation by 66.1% of GPs. Nonetheless, 73.9% thought that S2As were necessary for EPs requiring outpatient care. Conclusion. Although the benefit/risk ration of S2As is controversial and their analgesic efficacy seems to be more variable than that of low-dose morphine, they have an important place in the therapeutic arsenal of GPs to treat pain in EP.