Assessment of neuropathic pain management knowledge, attitudes, and practices among urology trainees and consultants in prostate cancer care: a survey-based study

Abstract

Abstract Background Effective neuropathic pain management is crucial in improving the quality of life for patients with prostate cancer. There is an abundance of research about cancer pain and guidelines that have been developed by World Health Organization including the analgesia stepladder, yet patients with cancer pain are still sub optimally analgesed. This is due to a variety of both patient and physician factors which include: lack of knowledge on the use of adjuvant medication, fear of addiction and poor characterization of the type of pain. This study intended to assess the knowledge, attitudes, and practices of urology trainees and consultants in the the context of neuropathic pain in prostatecancer care. Methods The study involved 91 urologists, comprising of junior registrars, medical officers and experienced specialists who are members of the South African Urological Association (SAUA). Data was collected through a 25-question web-based survey. The survey covered: demographic information, knowledge, attitudes, and practices related to cancer pain management. Results The study revealed that a significant proportion of urologists assessed neuropathic pain reactively, with only 8% of respondents being familiar with screening scales. Approximately, one-third preferred referrals, and 74% expressed confidence in self-treatment. Concerns regarding opioid prescription were observed in 40.4% of respondents. Furthermore, the usage of adjuvant medications was limited, with only 35% proficiently combining analgesia and adjuvants. Notably, 65% continued to escalate analgesic monotherapy. Conclusion Effective neuropathic pain management in prostate cancer care necessitates a multidisciplinary approach, comprehensive assessment and expertise in adjuvant medication usage. The discrepancies observed among urologists are likely due to variations in experience levels. The study identifies knowledge gaps and suboptimal practices in neuropathic pain management among urologists. Addressing these issues through education, awareness, and interdisciplinary collaboration is imperative to enhance patient outcomes and improve the quality of life for individuals with prostate cancer. This study underscores the need for improved education and interdisciplinary collaboration among urologists in managing neuropathic pain among prostate cancer patients. Enhancing these aspects is essential to achieve better patient outcomes and overall quality of life.

Keywords

• Neuropathic pain
• Prostate cancer
• Pain assessment
• WHO analgesic ladder
• DN4 questionnaire
• Pain DETECT questionnaire