Abstract
Pain control especially in advanced cancer patients is an unsolved problem of Bulgarian oncology. We aimed to evaluate the undertreatment of cancer pain among advanced cancer patients from Northwest Bulgaria and to identify patients' predictive factors for pain undermedication. As predictive factors the following were used: cancer diagnosis, gender, age, education, place of living, social activity and performance status. Pain undertreatment was evaluated by the Pain Management Index that links pain intensity with prescribed medication for its control. Pain was categorized by its intensity using NRS10 score in 4 groups 0 = no pain (0); 1 = mild (1-3); 2 = moderate (4-6); 3 = severe pain (7-10). Prescribed analgesic medication was categorized by the WHO's “analgesic ladder” also in 4 groups 0 = no medication; 1 = NSAIDS; 2 = mild opioids; 3 = strong opioids. PMI score was calculated by subtracting the pain score from analgesic score. Negative PMI score was considered as indicator of inadequate pain management. Descriptive statistics and Pearson's r correlation were used to determine the relationship of PMI with predictive factors. Medical records from 3096 hospitalizations were analyzed. 48 (0.015%) were excluded for incomplete data. 835 (27.4%) patients reported pain NRS10 < 4 at admission. Pain NRS10 > 4 experience 2213 (72.6%) patients. Mean pain intensity score was NRS10 =6.19. 152 (5%) patients had no pain treatment at all, another 341 (11.2%) had only NSAIDs. 892 (29.3%) patients were prescribed mild opioids, and 828 (27.2% ) used strong opioids. Negative PMI was calculated in 780 (25.6%) patients. Negative PMI was more often found in unemployed (31.1%) and in farm workers (31%). Analysis revealed that negative PMI increases with patients' age (p < 0.01), higher Karnofsky index (p < 0.01) and lower educational level (p < 0.01). There was no significant difference in PMI in both sexes and by patient's diagnosis. Undertreatment of cancer pain in Northwest Bulgaria is still an unsolved problem especially for elderly, less educated, farm workers and unemployed advanced cancer patients.
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