Over the past years, opioid analgesics use to treat chronic non-cancer pain (CNCP) has greatly increased.1Despite the existence of pain guidelines2,3,4 a majority of physicians still consider non chronic pain management as a challenge.5This study evaluate the current prescription practices of step 2 (S2A) and 3 (S3A) analgesics in northeast France.

An observational and retrospective study was conducted in a random sample of 1,000 patients using a large general health insurance reimbursement database in order to evaluate: 1) most commonly prescribed analgesics; 2) the socio-demographic data of pain patients and physicians; and 3) the adherence of physicians to French guidelines, including: i) initiate analgesic treatment with the lowest dosage, ii) do not prescribe S3A to opioid naïve patient and iii) do not associate S2A with S3A.

Almost 70% percent of the patients were women aged older than 60 years. Eighty-three percent were exclusively treated with S2A, 6% exclusively received S3A and 11% received opioid S2A with S3A. Tramadol, codeine and fentanyl transdermal were the most prescribed drugs. Fifty-one percent of patients did not start the treatment at the lowest dosage and nearly 15% of the patients receiving S3A were opioid-naïve.

This study highlights that there is still a vast domain to improve clinical practice of physicians in order to shift to best practices in the field of prescription of opioids to treat CNCP.