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Supportive Care in Cancer
Published in: Supportive Care in Cancer 2/2016

01-02-2016 | Original Article

Inadequate pain management in cancer patients attending an outpatient palliative radiotherapy clinic

Authors: Sherlyn Vuong, Natalie Pulenzas, Carlo DeAngelis, Sarah Torabi, Soha Ahrari, May Tsao, Cyril Danjoux, Toni Barnes, Edward Chow

Published in: Supportive Care in Cancer | Issue 2/2016

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Abstract

Purpose

The aim of this study is to assess the prevalence of undertreated cancer pain in an outpatient palliative radiotherapy clinic using the Pain Management Index (PMI).

Methods

A retrospective analysis of a prospective database to assess pain management was done on patients with cancer pain enrolled from January 2009 to March 2015 using recorded pain intensity (0–10) and baseline pain medications. The pain intensities were categorized into no pain (0), mild pain (1), moderate pain (2), and severe pain (3), and an analgesic score was assigned to the most potent pain medication the patient was taking during the time of data collection. “0” was assigned to no analgesics, “1” to non-opioids, “2” to weak opioids, and “3” for strong opioids based on the WHO guidelines. The PMI was calculated for each patient by subtracting the pain score from the analgesic score. A negative value indicated undertreatment, and a value of 0 or greater corresponded to adequate pain management.

Results

Three hundred fifty-four patients were included in the study. The incidence of inadequate pain management was 33.3 %, similar to that reported in our previous studies. Additionally, 106 patients were taking strong opioids and reporting severe pain despite being the PMI reporting adequately treated.

Conclusion

The rate of undertreatment is similar to that reported in past studies; however, the rates have shown a slight increase in our palliative radiotherapy clinic since the last assessment. Inadequate management of cancer pain continues to be a problem.
Literature
1.
Falk S, Dickenson AH (2014) Pain and nociception: mechanisms of cancer-induced bone pain. J Clin Oncol 32(16):1647–54PubMedCrossRef
2.
Goudas LC, Bloch R, Gialeli-Goudas M, Lau J, Carr DB (2005) The epidemiology of cancer pain. Cancer Invest 23(2):182–90PubMedCrossRef
3.
Auret K, Schug SA (2013) Pain management for the cancer patient—current practice and future developments. Best Pract Res Clin Anaesthesiol 27(4):545PubMedCrossRef
4.
Kwon JH, Hui D, Chisholm G, Hong WT, Nguyen L, Bruera E (2013) Experience of barriers to pain management in patients receiving outpatient palliative care. J Palliat Med 16(8):908–14PubMedPubMedCentralCrossRef
5.
Portenoy RK, Lesage P (1999) Management of cancer pain. The Lancet 353(9165):1695CrossRef
6.
Miller E (2004) The World Health Organization Analgesic Ladder. J Midwifery Womens Health 49(6):542–5PubMedCrossRef
7.
8.
Cleeland CS, Gonin R, Hatfield AK, Edmonson JH, Blum RH, Stewart JA, Pandya KJ (1994) Pain and its treatment in outpatients with metastatic cancer. N Engl J Med 330(9):592–6PubMedCrossRef
9.
Li KK, Harris K, Hadi S, Chow E (2007) What should be the optimal cut points for mild, moderate, and severe pain? J Palliat Med 10(6):1338–46PubMedCrossRef
10.
Deandrea S, Montanari M, Moja L, Apolone G (2008) Prevalence of undertreatment in cancer pain. A review of published literature. Ann Oncol 19(12):1985–91PubMedPubMedCentralCrossRef
11.
Greco MT, Roberto A, Corli O, Deandrea S, Bandieri E, Cavuto S, Apolone G (2014) Quality of cancer pain management: an update of a systematic review of undertreatment of patients with cancer. J Clin Oncol 32(36):4149–54PubMedCrossRef
12.
Mitera G, Zeiadin N, Kirou-Mauro A, DeAngelis C, Wong J, Sanjeevan T, Sinclair E, Danjoux C, Barnes E, Tsao M, Sahgal A, Chow E (2010) Retrospective assessment of cancer pain management in an outpatient palliative radiotherapy clinic using the pain management index. J Pain Symptom Manage 39(2):259PubMedCrossRef
13.
Mitera G, Fairchild A, DeAngelis C, Emmenegger U, Zurawel-Balaura L, Zhang L, Bezjak A, Levin W, Mclean M, Zeiadin N, Pang J, Nguyen J, Sinclair E, Chow E, Wong R (2010) A multicenter assessment of the adequacy of cancer pain treatment using the pain management index. J Palliat Med 13(5):589–93PubMedCrossRef
14.
Apolone G, Corli O, Caraceni A, Negri E, Deandrea S, Montanari M, Greco MT, Cancer Pain Outcome Research Study Group (CPOR SG) Investigators (2009) Pattern and quality of care of cancer pain management. Results from the Cancer Pain Outcome Research Study Group. Br J Cancer 100(10):1566–74PubMedPubMedCentralCrossRef
15.
Thavarajah N, Wong K, Zhang L, Bedard G, Wong E, Tsao M, Danjoux C, Barnes E, Sahgal A, Dennis K, Holden L, Lauzon N, Chow E (2013) Continued success in providing timely palliative radiation therapy at the Rapid Response Radiotherapy Program: a review of 2008–2012. Curr Oncol 20(3):e206–11PubMedPubMedCentralCrossRef
16.
17.
Lewis NL, Williams JE (2005) Acute pain management in patients receiving opioids for chronic and cancer pain. Continuing Education in Anaesthesia, Critical Care & Pain 5(4):127–9CrossRef
18.
Fainsinger RL, Nekolaichuk C, Lawlor P, Hagen N, Bercovitch M, Fisch M et al (2010) An international multicentre validation study of a pain classification system for cancer patients. Eur J Cancer 46(16):2896PubMedCrossRef
19.
Mishra S, Bhatnagar S, Goyal GN, Rana SPS, Upadhya SP (2012) A comparative efficacy of amitriptyline, gabapentin, and pregabalin in neuropathic cancer pain: a prospective randomized double-blind placebo-controlled study. Am J Hosp Palliat Med 29(3):177–82CrossRef
20.
Ney JP, Devine EB, Watanabe JH, Sullivan SD (2013) Comparative efficacy of oral pharmaceuticals for the treatment of chronic peripheral neuropathic pain: meta-analysis and indirect treatment comparisons. Pain Med 14(5):706–19PubMedCrossRef
21.
Mishra S, Bhatnagar S, Gupta D, Nirwani Goyal G, Jain R, Chauhan H (2009) Management of neuropathic cancer pain following who analgesic ladder: a prospective study. Am J Hosp Palliat Med 25(6):447–51CrossRef
22.
Caraceni A, Zecca E, Martini C, De Conno F (1999) Gabapentin as an adjuvant to opioid analgesia for neuropathic cancer pain. J Pain Symptom Manage 17(6):441–5PubMedCrossRef
23.
24.
de Wit R, van Dam F, Loonstra S, Zandbelt L, van Buuren A, van der Heijden K, Leenhouts G, Huijer A-SH (2001) The Amsterdam Pain Management Index compared to eight frequently used outcome measures to evaluate the adequacy of pain treatment in cancer patients with chronic pain. Pain 91(3):339–49PubMedCrossRef
25.
Bennett MI, Rayment C, Hjermstad M, Aass N, Caraceni A, Kaasa S (2012) Prevalence and aetiology of neuropathic pain in cancer patients: a systematic review. Pain 153(2):359–65PubMedCrossRef
Metadata
Title
Inadequate pain management in cancer patients attending an outpatient palliative radiotherapy clinic
Authors
Sherlyn Vuong
Natalie Pulenzas
Carlo DeAngelis
Sarah Torabi
Soha Ahrari
May Tsao
Cyril Danjoux
Toni Barnes
Edward Chow
Publication date
01-02-2016
Publisher
Springer Berlin Heidelberg
Published in
Supportive Care in Cancer / Issue 2/2016
Print ISSN: 0941-4355
Electronic ISSN: 1433-7339
DOI
https://doi.org/10.1007/s00520-015-2858-7

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