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01-07-2013 | Original Article

A cross-sectional survey of pain in palliative care in Portugal

Authors: Ferraz Gonçalves, Ana Almeida, Catarina Antunes, Maria Cardoso, Margarida Carvalho, Maria Claro, Francisca Coimbra, Inês Diniz, Bruno Fonseca, Emília Fradique, Edna Gonçalves, Florbela Gonçalves, Maria Gonçalves, Américo Magalhães, Paulo Pina, Conceição Pires, Paula Silva, Ricardo Silva, Rui Silva, Filipa Tavares, Laura Teixeira

Published in: Supportive Care in Cancer | Issue 7/2013

Abstract

Objective

The purpose of this work is to study the prevalence, intensity, and treatment of pain in Portuguese palliative care teams.

Methods

Twenty-one palliative care teams were invited to participate in a cross-sectional survey. Ten of these accepted and were included in the study. Data of all patients observed on the 18th week of 2011 were collected. The data collected concerning pain were: demographic data, pain intensity, drugs prescribed, and invasive techniques. The intensity of pain was rated using a five-point verbal rating scale from none to maximum. The Pain Management Index (PMI) was used to calculate the adequacy of the analgesia.

Results

A total of 164 patients were included in this study. One hundred fifty-one (92 %) had cancer. The median age was 71 years (16 to 95). Eighty-four (51 %) were females. Pain was directly assessed in 136 (83 %) of the patients, whereas 27 patients could not report pain because of cognitive failure. Of those directly assessed, 77 (57 %) had pain when they were assessed: 42 (55 %) mild, 25 (32 %) moderate, 9 (12 %) severe, and 1 (1 %) maximum. Non-opioid analgesics were used: paracetamol in 61 (37 %) and NSAID in 20 (12 %). Tramadol was the only opioid for mild to moderate pain used in 25 (15 %) patients. The opioids most used for moderate to intense pain were: morphine 74 (45 %), transdermal (TD) fentanyl 32 (20 %), and buprenorphine TD 28 (17 %). The adjuvants most used were: corticosteroids 38 (23 %), gabapentin 37 (23 %), and amitriptyline 15 (9 %). Only five (4 %) patients had a negative PMI, meaning an inadequate analgesia.

Conclusion

The general prevalence of pain is similar to that reported by other. The prevalence of moderate to severe pain is also similar to that reported in other studies, although severe pain is somewhat lower than indicated in most reports. According to the PMI, pain control was acceptable to good.

Jadad AR, Browman GP (1995) The WHO analgesic ladder for cancer pain management. JAMA 274:1870–1873PubMedCrossRef

Deandrea S, Montanari M, Moja L, Apolone G (2008) Prevalence of undertreatment in cancer pain. A review of published literature. Ann Oncol 19:1985–1991PubMedCrossRef

Breivik H, Cherney N, Collet B et al (2009) Cancer-related pain: a pan-European survey of prevalence, treatment, and patient attitudes. Ann Oncol 20:1420–1433PubMedCrossRef

Torvik K, Kaasa S, Kirkevold Ø, Rustøen T (2009) Pain in patients living in Norwegian nursing homes. Palliat Med 23:8–16PubMedCrossRef

Strohbuecker B, Mayer H, Evers GCM, Sabatowski R (2005) Pain prevalence in hospitalized patients in a German university teaching hospital. J Pain Symptom Manag 29:498–506CrossRef

Elliott AME, Smith BH, Penny KI, Smith WC, Chambers WA (1999) The epidemiology of chronic pain in the community. Lancet 354:1248–1252PubMedCrossRef

Larue F, Colleau SM, Brasseur L, Cleeland CS (1995) Multicentre study of cancer pain and its treatment in France. BMJ 310:1034–1037PubMedCrossRef

Cleeland CS, Gonin R, Hatfield AK et al (1994) Pain and its treatment in outpatients with metastatic cancer. N Engl J Med 330:592–596PubMedCrossRef

Beck SL, Falkson G (2001) Prevalence and management of cancer pain in South Africa. Pain 94:75–84PubMedCrossRef

10.

Fisch MJ, Lee JW, Weiss M et al (2012) Prospective, observational study of pain and analgesic prescribing in medical oncology out patients with breast, colorectal, lung, or prostate cancer. J Clin Oncol 30:1980–1988PubMedCrossRef

11.

Cherny NI, Baselga J, de Conno F, Radbruch L (2010) Formulary availability and regulatory barriers to accessibility of opioids for cancer pain in Europe: a report from the ESMO/EAPC Opioid Policy Initiative. Ann Oncol 21:615–626PubMedCrossRef

12.

Potter VT, Wiseman CE, Dunn SM, Boyle FM (2003) Patient barriers to optimal cancer pain control. Psycho-Oncology 12:153–160PubMedCrossRef

13.

Hill CS (1993) The barriers to adequate pain management with opioids analgesics. Sem Oncol 20(suppl 1):1–5

14.

Drayer RA, Henderson J, Reidenberg M (1999) Barriers to better pain control in hospitalized patients. J Pain Symptom Manag 17:434–440CrossRef

15.

Breuer B, Fleishman SB, Cruciani RA, Portenoy R (2011) Medical oncologists’ attitudes and practice in cancer pain management: a national survey. J Clin Oncol 29:4769–4775PubMedCrossRef

16.

Ferraz Gonçalves JA (2001) A Portuguese palliative care unit. Support Care Cancer 9:4–7CrossRef

17.

Kaasa S, Torvik K, Cherny N, Hanks G, de Conno F (2007) Patient demographics and centre description in European palliative care units. Palliat Med 21:15–22PubMedCrossRef

18.

van den Beuken-van Everdingen MHJ, de Rijke JM, Kessels AG, Schouten HC, van Kleef M, Patijn J (2007) Prevalence of pain in patients with cancer: a systematic review of the past 40 years. Ann Oncol 18:1437–1449

19.

Solano JP, Gomes B, Higginson IJ (2006) A comparison of symptom prevalence in far advanced cancer, AIDS, heart failure, chronic obstructive pulmonary disease and renal disease. J Pain Symptom Manag 31:58–69CrossRef

20.

Klepstad P, Kaasa S, Cherny N, de Conno F, Research Steering Committee of the EAPC (2005) Pain and pain treatments in European palliative care units. A cross sectional survey from the European Association for Palliative Care Research Network. Palliat Med 19:477–484PubMedCrossRef

21.

Stockler M, Vardy J, Pillai A, Warr D (2004) Acetaminophen (paracetamol) improves pain and well-being in people with advanced cancer already receiving a strong opioid regimen: a randomized, double-blind, placebo-controlled cross-over trial. J Clin Oncol 22:3389–3394PubMedCrossRef

22.

Axelsson B, Stellborn P, Ström G (2008) Analgesic effect of paracetamol on cancer related pain in concurrent strong opioid therapy. A prospective clinical study. Acta Oncol 47:891–895PubMedCrossRef

23.

Israel FJ, Parker G, Charles M, Reymond L (2010) Lack of benefit from paracetamol (acetaminophen) for palliative cancer patients requiring high-dose strong opioids: double-blind, placebo-controlled, crossover trial. J Pain Symptom Manag 39:548–554CrossRef

24.

Oscier C, Bosley N, Milner Q (2007) Paracetamol—a review of three routes of administration. Updat Anaesth 23:112–114

25.

McQuay H (2011) Evidence-based medicine: what is the evidence that it has made a difference? Palliat Med 25:394–397PubMedCrossRef

26.

Tassinari D, Drudi F, Rosati M, Tombesi P, Sartori S, Maltoni M (2011) The second step of the analgesic ladder and oral tramadol in the treatment of mild to moderate pain: a systematic review. Palliat Med 25:410.423PubMed

27.

http://www.infarmed.pt/prontuario/framepesactivos.php?palavra=dextropropoxifeno&rb1=0. Accessed 20 June 2012

28.

Hanks GW, de Conno F, Cherny N et al (2001) Morphine and alternative opioids in cancer pain: the EAPC recommendations. Br J Cancer 84:587–593PubMedCrossRef

29.

Ripamonti CI, Banderi E, Roila F (2011) Management of cancer pain: ESMO clinical practice guidelines. Ann Oncol 22(suppl 6):v257–v260

30.

Caraceni A, Pigni A, Brunelli C (2011) Is oral morphine still the first choice opioid for moderate to severe cancer pain? A systematic review within the European Palliative Care Research Collaborative guidelines project. Palliat Med 25:402.409PubMed

31.

Tassinari D, Drudi F, Rosati M, Maltoni M (2011) Transdermal opioids as front line treatment of moderate to severe cancer pain: a systematic review. Palliat Med 25:478–487PubMedCrossRef

32.

Bennett MI (2011) Effectiveness of antiepileptic or antidepressant drugs when added to opioids for cancer pain: systematic review. Palliat Med 25:553–559PubMedCrossRef

33.

Wiffen PJ, Collins S, McQuay HJ, Carroll D, Jadad A, Moore RA (2010) WITHDRAWN. Anticonvulsant drugs for acute and chronic pain. Cochrane Database Syst Rev 20(1):CD001133

34.

Hardy JR, Rees E, Ling J, Burman R, Feuer D, Broadley K, Stone P (2001) A prospective survey of the use of dexamethasone on a palliative care unit. Palliat Med 15:3–8PubMedCrossRef

35.

Lundström S, Fürst CJ (2006) The use of corticosteroids in Swedish palliative care. Acta Oncol 45:430–437PubMedCrossRef

36.

Lussier D, Portenoy RK (2004) Adjuvant analgesics in pain management. In: Doyle D, Hanks G, Cherny N, Calman K (eds) Oxford textbook of palliative medicine, 3rd edn. Oxford University Press, Oxford, pp 349–378

37.

Ferraz G, Cordero A, Almeida A et al (2012) A survey of the sedation practice of Portuguese palliative care teams. Support Care Cancer 20:3123–3127CrossRef

Title: A cross-sectional survey of pain in palliative care in Portugal
Authors: Ferraz Gonçalves
Ana Almeida
Catarina Antunes
Maria Cardoso
Margarida Carvalho
Maria Claro
Francisca Coimbra
Inês Diniz
Bruno Fonseca
Emília Fradique
Edna Gonçalves
Florbela Gonçalves
Maria Gonçalves
Américo Magalhães
Paulo Pina
Conceição Pires
Paula Silva
Ricardo Silva
Rui Silva
Filipa Tavares
Laura Teixeira
Publication date: 01-07-2013
Publisher: Springer-Verlag
Published in: Supportive Care in Cancer / Issue 7/2013
Print ISSN: 0941-4355
Electronic ISSN: 1433-7339
DOI: https://doi.org/10.1007/s00520-013-1746-2

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