Procedural pain: acknowledgement of the issue by palliative care professionals

Abstract

An optimal pain control is a constant challenge for palliative care professionals. As with all treatment and medical assistance processes, palliative care patients can undergo potentially painful procedures. Procedural pain is therefore a form of breakthrough pain that should be averted and treated adequately in order to improve the quality of life of terminally ill patients. Detection and control of procedural pain can be effectively achieved only if medical operatives have the necessary training. In order to assess the knowledge and awareness of this issue, palliative care workers of the home care and residential care staff of our Hospice were given a specific questionnaire to complete. 27 doctors and 36 nurses were interviewed. 96% of doctors and 90% of nurses indicated knowledge of the definition of procedural pain. Among doctors, 85% state that they prescribe a medication for intense breakthrough pain, although only 65% of nurses claim to be able to find them amongst available prescriptions. For both operative categories, procedural pain affect the quality of life of patients, but only 68% of nurses and 77% of doctors interviewed ordinarily detect it. The procedure most commonly believed to be a source of procedural pain is mobilisation, followed by medication. Overall, operatives think that in 84% of the situations, procedural pain is appropriately managed in their own setting. Our results show evidence of high levels of awareness about procedural pain by palliative care professionals. However, this does not seem to be reflected in its systematic detection al the bedside nor in a regular prescription of appropriate medication to control it, which results in a sub-optimal management of this type of breakthrough pain. Although the majority of the operatives apply their theoretical training to their medical practice, an increasing appreciation of the importance of procedural pain remains an important goal to improve these results, which will be compared to the findings of a targeted survey shortly to be conducted among patients.