Cancer Pain Assessment Research Articles

Cancer pain part 1: causes and classification

Pain is a significant problem in patients with cancer. Understanding the causes and types of cancer pain, thorough pain assessment and use of individualised pain management strategies can help to improve quality of care and pain relief for patients with cancer This article provides an overview of cancer pain and the effects this may have on patients and their carers. The nurse's role in understanding pain and interventions that may help to minimise pain are discussed. Assessment and management of cancer pain will be explored in a subsequent article.

AOS20 Effectiveness of a self-reporting pain assessment tool at the bedside of inpatients with cancer

<h3>Background</h3> Pain is common in cancer and a patient's self-report of pain is an essential first step in the management of such pain. However, according to reports of many studies, cancer pain is often managed inadequately because we do not listen to patients' complaints of pain and tend to underestimate their cancer pain. The aim in this study was to assess the effectiveness of self-assessments of pain intensity at the bedside of inpatients, using a self-reporting pain board. <h3>Methods</h3> Pain assessments were done with patients' answers to questions asked by the medical staff that were recorded with a numerical rating scale (NRS) for 3 days and then for the next 3 days patients reported pain using a self-reporting pain board with moving indicators, representing 0–10 on the NRS, and they reported the frequency of their breakthrough pain. <h3>Findings</h3> Fifty consecutive inpatients admitted to the Oncology Department of Chungbuk National University Hospital were included in this observational prospective study from February 2011 to December 2011. Reliability in the patients' self-reported pain versus that recorded by the medical staff increased from 74% to 96% with use of the self-reporting pain board (<i>p</i>=0.004). The difference (mean<mml:math><mml:mrow><mml:mo>±</mml:mo></mml:mrow></mml:math>standard deviation [SD]) between the NRS reported by patients and that reported in medical records decreased from 3.16<mml:math><mml:mrow><mml:mo>±</mml:mo></mml:mrow></mml:math>2.08 to 1.00<mml:math><mml:mrow><mml:mo>±</mml:mo></mml:mrow></mml:math>1.02 (<i>p</i><0.001). Patients' satisfaction with pain management increased from 54% to 82% (<i>p</i>=0.002). Moreover, the difference in the workload of medical staff in assessing patients' pain (mean<mml:math><mml:mrow><mml:mo>±</mml:mo></mml:mrow></mml:math>SD) decreased from 46.9<mml:math><mml:mrow><mml:mo>±</mml:mo></mml:mrow></mml:math>15.5 to 24.3<mml:math><mml:mrow><mml:mo>±</mml:mo></mml:mrow></mml:math>11.2 (<i>p</i><0.001). <h3>Interpretation</h3> We suggest that this self-reporting bedside pain assessment tool provides a reliable and effective means for the assessment of cancer pain in inpatients. The authors declared no conflicts of interest.

Assessment and management of patients with cancer pain

This article aims to update nurses on cancer pain incidence, causes, assessment and management approaches. Cancer patients can be nursed in a variety of settings: in acute hospitals and in the community either at home, in nursing homes or hospices. An understanding of cancer pain and the different approaches to assessment and management will help ensure that nurses in different clinical settings are able to support patients and their families when dealing with the symptoms of cancer-related pain.

Assessment and treatment of cancer pain: From Western to Eastern.

Satisfactory control of the cancer pain remains the single most important element in palliative care, as failure of pain relief is a major threat to the quality of life. Inadequate classification and assessment would unavoidably lead to inappropriate and impractical treatment of cancer pain, which has been a striking challenge in cancer clinical practice for the past several decades. While the cancer pain characteristics are influenced by physiological, psychological, pathological, cultural and even social factors, a comprehensive assessment and an individualized plan of care should be provided throughout the course of illness. This review attempted to describe the framework, illustrate the present evidence supporting current classification methodologies and assessment approaches, and demonstrate the advance in multidisciplinary interventions for cancer pain syndrome, including Western and Traditional Chinese medicine.

Establishment of an evidence-based comprehensive cancer pain assessment for cancer patient

Establishment of an evidence-based comprehensive cancer pain assessment for cancer patient

Pain Control in Head and Neck Cancer

ABSTRACTObjectiveTo describe the treatment of head and neck cancer pain in KHMC and to evaluate the predictive factors for inadequate management between April 2007 and March 2010.SubjectsTwenty-five patients with head and neck cancer.Main measuresPatients rated prevalence and severity of pain and functional impairment related to pain. Doctors reported patients’ cancer characteristic, performance status, pain severity, and analgesic drugs ordered.Results57% (14/25) of patients with cancer reported pain due to their disease, and, of those with pain, 69% (9/13) rated their worst pain at a level that impaired their ability to function. 30% (5/12) were reported as receiving no drugs for their pain. Of the 18 patients in pain for whom information on treatment was available 51% (41/18) were not receiving adequate pain reliefs, according to an index based on the World Health Organization's guidelines. Doctors were found to underestimate the severity of their patients’ pain. Younger patients, patients without metastasis disease, patients with a better performance status, and patients who rated their pain as more severe than their doctors did were at greater risk for under treatment of their pain.ConclusionIn the light of the high prevalence and the severity of pain among patients with head and neck cancer, the assessment and treatment of cancer pain was inadequate, emphasizing the need for changes in patient care.

Neuropathic Pain Is a Common Feature in Ehlers-Danlos Syndrome

Neuropathic Pain Is a Common Feature in Ehlers-Danlos Syndrome

Cancer pain assessment and care

Cancer pain assessment and care

Comprehensive Assessment and Management of Cancer Pain

Comprehensive Assessment and Management of Cancer Pain

Development of a Personal Digital Assistant (PDA) System To Collect Symptom Information from Home Hospice Patients

Previous studies have found that inappropriate assessment of cancer pain can lead to inadequate pain management. To improve assessment, it may be helpful to collect real-time data in a natural environment using computerized ecological momentary assessment (cEMA). Therefore, the aim of the study was to develop a personal digital assistant (PDA) system to collect information on symptoms such as pain and mood states in patients with cancer using cEMA. Following a pilot study in inpatients with cancer, the second phase of the study involved patients with terminal cancer receiving home hospice care. These patients were asked to record their symptoms in a PDA (a palm-sized portable device) several times per day for a week when they took rescue medications and when an alarm sounded. At the end of the week, an interview on the usability of the device was conducted and overall response rates were calculated. Fifteen patients completed the second phase of the study. Their median age was 64 years and the median survival time after the study period was 22 days. The overall response rates were 90.3% to the sound of the alarm and 80.2% after taking rescue medications. The user-friendliness of the device was rated as 8.8 on a scale of 0 (worst) to 10 (best). The cEMA technique using a PDA might be applicable to patients with cancer in palliative care to evaluate symptoms in a natural setting. This system may also be useful for managing symptoms such as pain and mood states in patients with cancer.

Assessment and classification of cancer pain

Pain is probably the most feared symptom in cancer, and pain control has received considerable attention. Adequate pain management requires precise and thorough assessment including universally accepted definitions; an area with a great potential for improvement. There is still little consensus on how to categorize or classify cancer pain. The recent literature was reviewed in order to evaluate the development in cancer pain classification and assessment, respectively. At present, only three standardized, systematically developed but not fully validated pain classification systems exist. However, their use in clinical practice is relatively limited, with one exception; the Edmonton Classification System for Cancer Pain, which is now subject to a large, international validation study. The findings from the cancer pain assessment literature reveal a plethora of instruments indicating that tool development is a continuous process, which does not follow systematic guidelines. The driving force is most often specific research interests in a limited number of issues related to cancer pain. There is still no universally accepted tool for cancer pain assessment or general agreement on which domains to include in a classification system. In order to improve cancer pain management and research, we need to agree internationally on how to classify and assess cancer pain. Consensus can only be achieved through worldwide research collaborative work employing a systematic, stepwise process based on the existing body of knowledge, patient and expert opinions and clinical validation studies.

Pain assessment tools in palliative care: an urgent need for consensus

At present, there is no universally accepted cancer pain assessment tool for use in palliative care (PC). The European Palliative Care Research Collaborative (EPCRC), therefore, aims to develop an international consensus-based computerised pain assessment tool. As part of this process, we have performed (1) a literature review on pain assessment tools for use in the PC and (2) an international expert survey to gain information on the relevant dimensions for pain assessment in PC. 230 publications were identified, only six met the inclusion criteria. Three further articles were identified through manual searching, totalling 11 different pain assessment tools. Nine tools were multidimensional. Pain intensity was assessed in seven, using various numerical/verbal rating scales (NRS/VRS); five tools focused on pain management. Three publications did not identify the rationale for the need to develop a new tool, and the selection procedure for items/dimensions was not described in six tools. Patient and/or professional expert groups were involved in the development of five tools and only two tools were extensively validated or cross-culturally tested. Thirty-two experts (71%) completed the expert survey and identified ‘intensity’, ‘temporal pattern’, ‘relief/exacerbation’, ‘pain quality’ and ‘location’ as the five most relevant dimensions. Most preferred assessment of ‘pain intensity’ was by NRS rather than VRS. Time windows extending 24 h were regarded as less relevant. Development of PC pain assessment tools seems to be a continuous process, which does not adhere to systematic guidelines, thus does not contribute to a universally accepted tool. No tool contained all relevant dimensions as defined by the experts. Many tools focused on particular dimensions, suggesting that specific research interests may drive the tool development process. Extensive literature reviews, expert and patient input and clinical studies are a needed approach in the development of a new consensus-based pain assessment tool.

Cancer pain: Perspectives of a medical oncologist

Pain is highly prevalent in cancer patients and primarily managed by medical oncologists. This article reviews cancer pain syndromes related to cancer and sequelae of treatment. We discuss the assessment and treatment of cancer pain with pharmacotherapy and chemotherapy, and the role of pain specialists. There are numerous barriers to care, which arise from both the physician and patient. We review approaches that diminish these barriers to improve treatment of cancer pain.

Cancer pain assessment – Can we predict the need for specialist input?

We can anticipate that failure to assess cancer pain adequately will inevitably lead to inappropriate application of pain management options. However, it is not always standard practice to teach the limitations of the question ‘How bad is the pain?’, as well as the need to consider what may complicate pain management or be a poor prognostic factor for pain control. These issues may complicate cancer pain assessment and require specialist consultation. An internationally accepted classification system for cancer pain could provide the basis for a multidimensional assessment and a common language for clinical and research work. Research dating back to the late 1980s has resulted in the development of the Edmonton Classification System for Cancer Pain. This includes many of the factors that may be prognostic for the complexity of cancer pain management and can assist an inexperienced clinician in anticipating the need for specialist advice.

Assessment of cancer pain

19500 Background: This study investigates: 1) The concordance between patients and staffs’ standard use of the numerical rating scale (NRS) for pain, in which 1–4 is mild pain, 5–6 is moderate and 7 and above is severe; 2) The relative importance of functional impairment secondary to pain in patients’ pain ratings. Methods: Patients with cancer and current or previous pain (N=178) were asked to complete a fifteen minute interview with open-ended questions about their perception of pain. Results: When asked to define mild, moderate and severe pain according to the NRS, 65% of patients gave numbers that did not meet standard definitions as noted above. When asked to define mild, moderate and severe pain in general, 38% differentiated severity of pain based on its impact on their ability to fulfill activities of daily living (ADLs) and 39% differentiated it based on their emotional reactions. When asked to define tolerable pain, 28% described it in terms of its impact on ADLs, while 30% described it in terms of the NRS. For those patients who used a NRS, the mean value for tolerable pain was 4.9 (range 2–8) and the mean value for intolerable pain was 8.1 (range 5–10). 26% of patients defined satisfactory pain control based its impact on ADLs while only 2% defined it according to a NRS. 68% of patients reported that pain interfered with their ADLs, however only 33% reported that pain medication interfered. Conclusions: There is discordance between the standard definition of the NRS and patient perceptions of it, suggesting it should be supplemented by other types of pain assessment. Based on NRS, patients tolerate higher levels of pain than expected. Patient satisfaction with pain control is more dependent upon ability to complete ADLs than on a numerical rating of pain. Therefore, patients’ ability to function at an acceptable level should be part of the standard pain assessment. No significant financial relationships to disclose.

Management of pain in patients (PTS) receiving active therapy for cancer

19645 Background: The World Health Organization (WHO) estimates suggest that moderate to severe pain is experienced by one- third of pts receiving active therapy for their disease and by 60–90% of patients with advanced disease. Procedures that make pain assessment and effective management strategies a routine part of every patient care are recommended. The aim of this study was to integrate nursing intervention with physician management of cronic cancer pain experienced by pts receiving active therapy for cancer. Methods: An Oncology Nurse measured pain in all patients (universal screening) presenting at the Day Hospital for active therapy. Pain was measured using a validated instrument: the Visual Analog Scale (VAS). The pain intensity VAS scale is a 10 cm line anchored on either end by the terms least possible pain and worst possible pain. In addition. the Memorial Pain Assessment Care (MPAC) that consists of 3 VAS scales that measure pain intensity, pain relief and mood and a set of pain severity descriptors adapted from the Tursky rating scale was used. Results: From April 2004 to June 2006 a total of 704 pts were evaluated for pain, 334 (47%) males and 370 (53 %) females with median age 65 years (range 19–85). Results of pain measurement can be synthesized as follows: Pts with VAS = 4 were referred to the oncologist on the same day that pain was measured and analgesics were prescribed according to intensity and type of pain. Conclusions: Results indicate that pain can be universally evaluated and successfully managed in an Oncology Day Hospital. Assessment and treatment of cancer pain should be integrated into routine cancer care. Intervention by the oncology nursing staff is an integral part of effective cancer pain management. No significant financial relationships to disclose. [Table: see text]

Pre-admission escalation rate of daily opioid consumption (PERDOC), and total morphine equivalent daily dose on the first complete day of admission (D1-MEDD) to a tertiary-level palliative care unit (TPCU): Correlates and predictors in patients with advan

9065 Background: Although animal laboratory studies attest to opioid tolerance (OT), it can be difficult in clinical practice to determine whether substantive escalation in opioid dose (average of &gt;5% per day between initial daily dose and maximum daily dose to date) is due to disease progression (DP) or decreased opioid responsiveness, which in turn may be due to OT or other factors. Our study aims were to determine (1) the frequency of PERDOC&gt;5%, (2) the correlates and predictors of PERDOC&gt;5% and D1-MEDD. Methods: We retrospectively examined TPCU patient database records for demographics, physician rating of PERDOC in the Edmonton Staging System (ESS) for cancer pain classification, Edmonton Symptom Assessment System (ESAS) scores, and D1-MEDD. Consecutive 1st admission data on patients surviving &gt;3 days were included in the initial analysis. Using complete data, logistic regression and multiple regression models were created with PERDOC&gt;5% and logn D1-MEDD, respectively, as dependent variables. Results: From 1,351 patients who met the initial descriptive analysis eligibility criteria, 1212 (90%) had an ESS rating for PERDOC. The prevalence of PERDOC&gt;5% was 274/1212 (19.3%). Bivariate analysis (N=969, complete data) showed that PERDOC&gt;5% was positively associated (p&lt;0.05) with younger age, neuropathic pain component (NPC), a pathological level of psychological distress (PLPD), substance abuse, higher D1-MEDD, and higher ESAS pain score (ESAS-P). In the multivariate analysis, NPC (Odds ratio: 2.1, 95% confidence interval: 1.5–2.9), PLPD (1.7, 1.2–2.6), and higher D1-MEDD (2.2, 1.03–4.7) were the strongest independent positive predictors, and ESAS-P (1.01, 1.003–1.02) remained as a weaker predictor. In the D1-MEDD regression model, positive predictors (p&lt;0.05) were younger age, NPC, incident pain, PERDOC&gt;5%, PLPD, ESAS-P and ESAS anxiety scores. Conclusions: Aside from OT and DP, the multiple predictors identified for PERDOC&gt;5% and D1-MEDD underscore the need for a systematic multidimensional assessment of cancer pain that incorporates psychological and physical characteristics. No significant financial relationships to disclose.

Update in Cancer Pain Syndromes

Cancer pain assessment and management are integral to palliative medicine. This paper reviews recent publications in the period 1999-2004 in the broad categories of epidemiology, pain assessment, nonpharmacologic approaches to cancer pain (radiation therapy, anesthetic blocks, palliative surgery and chemotherapy, complementary and alternative medicine), and in nociceptive pain, neuropathic pain, visceral pain, and bone pain.

The Measurement of Pain from Metastatic Bone Disease: Capturing the Patient's Experience

Pain is prevalent for large numbers of patients with metastatic cancer, and this pain is often due to bone metastases. Despite the availability of effective pain treatments and various pain management guidelines, multiple studies document the undertreatment of pain in patients with cancer. The most frequently identified barriers to appropriate pain management are physician underestimation of the patient's pain, inadequate pain assessment, and patient reluctance to report pain. A first step toward reducing inadequate pain control in clinical practice is adequate assessment of cancer pain using validated pain measurement instruments. Using treatment for bone pain as an example, we discuss how patient satisfaction measures and self-report measures of pain and other symptoms, symptom interference with patient function, and related adverse effects can be combined with appropriate trial design to provide the information needed to choose the best possible treatment for bone pain. Symptom assessment needs to be done via standardized questionnaires, administered at appropriate times during the trial. The Brief Pain Inventory uses 11-point numerical rating scales to measure both pain severity and the resulting functional interference caused by pain. These severity and interference ratings can be further categorized as mild, moderate, or severe, as required to implement most pain management guidelines and define outcome expectations for clinical trials. Consistent pain measurement and standardized recording of analgesic use across clinical trials would enhance comparability and increase the chances that treatment decisions for management of bone pain could be evidence based. These and other considerations in the design of clinical trials are discussed.

The relationship of plasmaβ-endorphins and pain dimensions in primary liver cancer patients using the Chinese Cancer Pain Assessment Tool

Evidence suggests a mind-body link in pain experience. Many studies have focused on the link between endorphins and pain intensity. However, there is a lack of research that examines the bio-psycho-socio-cultural link from a multidimensional perspective in cancer pain experience. Methods: This cross-sectional correlational study investigated the relationship between plasma β-endorphin level (objective variable) and the pain dimensions (subjective variables). Venous blood samples were taken from 76 Chinese primary liver cancer patients by convenience in a cancer centre and plasma β-endorphin levels were measured by radioimmunoassay. The Chinese Cancer Pain Assessment Tool (CCPAT) was employed to assess the pain dimensions which include: functional, psychosocial, pharmacological, emotional, pain beliefs and meanings, pain intensity. Results and Discussion: Sixty-eight men and eight women were recruited the mean age was 49.8 (±12.2) years. Thirty-two (42.1%) patients experienced varying degrees of pain. The mean β-endorphin level was 270.4 (± SEM 11.4)pg/ml. The mean weighted CCPAT scores were 27.8 (±8.9), 14.6 (±2.1), 19.0 (±4.1), 23.1 (±6.4), 70.1 (±8.3) and 0.8 (±1.5) for functional, psychosocial, pharmacological, emotional, pain beliefs and meanings, pain intensity dimensions respectively. Spearman's correlations demonstrated a significant relationship between β-endorphin level and the psychosocial dimension scores (r = −0.25, p = 0.028) in the pain and control groups. Inverse correlations between plasma β-endorphin level and all CCPAT pain dimension scores were found. The results are consistent with those of a previous study by Chung et al. in 2002. Conclusions: Our study suggests that there is a mind-body link in cancer pain experience. Establishment of this link will enhance more accurate pain assessment and provide a basis for multidisciplinary pain interventions, fostering better pain management.