Knowledge Of Cancer Pain Management Research Articles

Comparative Effectiveness of Video and Face-to- Face Sessions to Educate Hospitalized Patients on Cancer Pain Management

Objective: Patients’ lack of knowledge of cancer pain management affects pain outcomes. This study compared the effectiveness of cancer pain management achieved in a previous retrospective study (“P-group”), in which hospitalized cancer pain individuals received no pain education, with the pain management achieved by 2 study groups. One group received pain management information via video sessions (“V-group”) and the other via face-to-face coaching (“F-group”). The study’s secondary aims were to compare the 2 interventions’ psychological, quality-of-life, and opioid-consumption impacts. Materials and Methods: This single-blinded, randomized, controlled trial enrolled hospitalized cancer pain patients aged between 18 and 70 with an Eastern Clinical Oncology Group performance status < 4. They were assigned to V- and F-groups to receive information on managing cancer pain. “Successful pain control” was defined as “no to mild pain” or a numerical rating scale score < 4 on Day 6. Pain intensity and opioid consumption (morphine-equivalent daily dosage) were recorded daily from baseline to Day 6. Psychological status (Hospital Anxiety and Depression Scale) and quality of life (Functional Assessment of Cancer Therapy–General) were assessed at baseline and Day 6. Results: Fifty-nine participants were analyzed (V-group: 31; F-group: 28). Both groups had significantly higher successful pain outcomes than the P-group (P < .001). The V- and F-groups had no significant differences in successful pain control (20 [65%] vs 19 [68%]; P = .787), psychological effects, quality of life, or opioid consumption. Conclusions: Video sessions are an alternative means of educating hospitalized cancer pain patients and reducing healthcare providers’ workloads.

Factors Affecting Nurses' Performance of Cancer Pain Management in a Tertiary Hospital.

More than 60% of patients with advanced cancer experience pain, and uncontrolled pain reduces the quality of life. Nurses are the closest healthcare providers to the patient and are suitable for managing cancer pain using pharmacological and non-pharmacological interventions. This study aimed to identify factors affecting the performance of cancer pain management among nurses. This study was conducted among 155 participating nurses working at a tertiary hospital who had experience with cancer pain management. Data collection was performed between October 18, 2021 and October 25, 2021. Data analysis was conducted using descriptive statistics, the independent-sample t-test, one-way analysis of variance, and hierarchical regression analysis. There were 110 subjects (71.0%) who had no experience of cancer pain management education. The results of regression analysis indicated that barriers included medical staff, patients, and the hospital system for cancer pain management (β=0.28, P<0.001). The performance of cancer pain management was also affected by experience of cancer pain management training (β=0.22, P=0.007), and cancer pain management knowledge (β=0.21, P=0.006). The explanatory power of the variable was 16.6%. It is crucial to assess system-related obstacles, as well as patients and medical staff, in order to improve nurses' cancer pain management performance. A systematic approach incorporating multidisciplinary interventions from interprofessional teams is required for effective pain management. Furthermore, pain management education is required both for cancer ward nurses and nurses in other wards.

Knowledge, Practices, and Perceived Barriers in Cancer Pain Management at Oncology Units: A Cross-Sectional Survey of Medical Staff in China.

BackgroundDespite the great signs of progress in cancer pain management in China, the associated pain remains under-treated. Poor knowledge among the medical staff is an important factor contributing to the under-treatment of cancer pain. This study aimed to evaluate the knowledge, practices, and perceived barriers in cancer pain management among the medical staff at oncology units in China.Patients and MethodsA cross-sectional survey was conducted with the medical staff (including physicians, nurses, and pharmacists) at oncology units in tertiary hospitals of China between December 2020 and January 2021. The questionnaire assessed the knowledge, practices, and perceived barriers in cancer pain management.ResultsA total of 1262 medical staff responded to the questionnaire; the response rate was 94.2%. Most participants had good knowledge of the three-step analgesic ladder of the World Health Organization (WHO) and the National Comprehensive Cancer Network (NCCN) guidelines for Adult Cancer Pain. Knowledge deficit was prominent in questions on opioid dose titration and rotation and adverse effects of opioids; the correct response rate was less than 40%. Training, work experience in oncology, and education level were significantly related to knowledge of cancer pain management (all P < 0.001). In clinical practice for cancer pain management, approximately 57.2% of medical staff were unfamiliar with opioid dose titration and rotation; only 14.4% treated cancer pain through multidisciplinary collaboration. Poor medication compliance, difficult individualized analgesia protocols, and insufficient multidisciplinary participation were the most frequently perceived barriers by the medical staff for pain management.ConclusionThese findings suggested a further need for integrating recent guidelines to strengthen continued training (especially among juniors and those with low education levels) and patient education to improve the knowledge and clinical practices of cancer pain management among the medical staff in China. Multi-disciplinary management is required for the effective treatment of cancer pain.

Practices and Hindrances in Cancer Pain Management: Results of a National Multi-Cancer Center Survey Among Healthcare Professionals in China.

BackgroundInadequate control of cancer-related pain in China is an ongoing problem. This study investigated the practices of cancer pain (CP) management at major cancer centers in China and perceived hindrances and knowledge of CP management among health professionals.MethodsFrom September to October 2019, a survey was conducted using electronic questionnaires via the internet to investigate the practices, and perceived hindrances and knowledge in managing CP among healthcare professionals from 7 provincial cancer centers in China. The questionnaire included demographic data, the professionals’ practices among their own patients, their opinions regarding hindrances to CP management, and knowledge of CP management.ResultsWe gathered validated responses from 411 anonymous healthcare professionals, with 82.2% (411/500) of response rate. Based on the analysis of these 411 questionnaires, the results demonstrated that CP was prevalent among patients with cancer, while moderate-to-severe pain took a great proportion. CP management was inadequate for a significant proportion of the patients with CP. Pain assessment, analgesic treatment, attention to adverse effects of analgesic, and multidisciplinary management were usually ineffectual in many cases. The duration of work experience did not significantly affect CP management. The respondents considered that both patients and healthcare professionals were responsible for the undermanagement of CP. Only 26 (6.3%) respondents were able to answer correctly all 10 of the professional questions regarding CP.ConclusionCP is commonly undermanaged in China. Effective pain control requires the implementation of standards, and the sufficient attention and training of healthcare professionals.

Cancer pain management in China: current status and practice implications based on the ACHEON survey.

PurposeCancer pain can seriously impact the quality of life (QoL) of patients, and optimal management practices are therefore of paramount importance. The ACHEON survey queried physicians and patients from 10 Asian countries/regions to assess current clinical practices in cancer pain management in Asia. This study presents the data obtained for cancer pain management in mainland China, with an emphasis on practices related to opioid drugs.Materials and methodsIn several tertiary hospitals across China, 250 patients experiencing cancer pain and 100 physicians were surveyed on questions designed to assess current cancer pain management practices and cancer pain impact on QoL.ResultsThe patient survey showed that 88% of patients reported moderate-to-severe cancer pain, with a median duration of 6 months. The physician survey showed that medical school/residency training with regard to cancer pain management was inadequate in ~80% of physicians. A total of 80% of physicians and 67.2% of patients reported that pain scale was used during pain assessment; 84% of physicians expressed that physician-perceived pain severity was not completely consistent with actual pain the patient experienced. Of the 147 patients who recalled the medication received, 83.7% were administered opioid prescriptions. Of the 240 patients who received treatment, 43.8% perceived the inadequacy of controlling pain. The primary barriers from physicians perceived to optimal pain management included patients’ fear of side effects (58%), patients’ fear of addiction (53%), patients’ reluctance to report pain (43%), physicians’ reluctance to prescribe (29%), physicians’ inadequacy of pain assessment (27%) and excessive regulation of opioid analgesics (47%).ConclusionKnowledge of cancer pain management should be strengthened among physicians. Quantitative pain assessment and principle-based pain management should be combined to achieve pain relief. Misconceptions about opioids in patients and physicians and poor report about pain should be overcome through training/education to improve QoL of patients impacted by pain.

Application of transitional care model in cancer pain management after discharge: a randomized controlled trial

Abstract Objective We sought to determine any benefits of applying a transitional care model in the continuum of cancer pain management, especially after patients' discharge from the hospital. Methods A total of 156 eligible participants were recruited and randomly assigned into intervention or control groups. The control group received standard care, while the intervention group received extra, specialized transitional care of pain management. Outcomes were measured at weeks 0 and 2–4 and included demographic data, the Brief Pain Inventory, Global Quality of Life Scale, and Satisfaction Degree of Nursing Service. Adequacy of analgesia and severity of pain were assessed with the Pain Management Index and interview findings. Results After 2–4 weeks of intervention, there was a significant difference in the change in average pain score between intervention and control groups ( P P P Conclusions The application of a transitional care model in cancer pain management after discharge could help patients to improve their cancer pain management knowledge and analgesics compliance. In addition, the continuum of care service will contribute to effective communication between health care providers and patients, which could further improve their relationship.

Physicians' Practice, Attitudes Toward, and Knowledge of Cancer Pain Management in China.

To evaluate physicians' current practice, attitudes toward, and knowledge of cancer pain management in China. We conducted a face-to-face survey of physicians (oncologists, internists, hematologists) who are responsible for the care of cancer patient of 11 general hospitals in Sichuan, China between December 2011 and December 2013. Statistical analyses were performed using SPSS (SPSS, Chicago, IL) software. A 23-item questionnaire was designed and distributed to 550 physicians in 11 medical facilities in China. Five hundred (90.90%) physicians responded. About one-third (32.6%) of physicians assessed patients' pain rarely, and 85.5% never or occasionally treated patients' cancer pain together with psychologists. More than half of physicians indicated that opioid dose titration in patients with poor pain control and assessment of the cause and severity of pain were urgently needed knowledge for cancer pain management. Inadequate assessment of pain and pain management (63.0%), patients' reluctance to take opioids (62.2%), and inadequate staff knowledge of pain management (61.4%) were the three most frequently cited barriers to physicians' pain management. Physicians' positive attitudes toward cancer pain management need to be encouraged, and active professional analgesic education programs are needed to improve pain management in China.

A physician's practice, attitude and approach for the management of palliative care for cancer.

112 Background: Pain is the most frequent and persistent symptom experienced by cancer patients. Thus, exploring how to achieve the best outcome of cancer pain management in China is clearly extremely important. Our study focuses on the Chinese physicians' current clinical practice, attitudes, toward and barriers to opioid use, and knowledge of cancer pain management. Methods: A face to face survey include 23 items was designed and conducted to the doctors working with cancer pain managements (oncologists, internists, hematologists, et al) responsible for the care of patients with cancer in 11 tertiary hospitals in China. Descriptive statistics were used to characterize the total sample and for multiple choice questions and each item. Chi-square analysis was used to examine the difference between categorical variables. Results: 500 questionnaires were received out of 550. Most (62.2%) physicians assessed patients’ cancer pain every day, but 85.5% never or occasionally treated patients’ cancer pain together with psychologists. Most respondents appreciated that &gt; 50% of patients with cancer experience severe chronic pain warranting analgesic therapy (73.5%), and that this therapy could control pain adequately in &gt; 50% of patients (77.2%). More than half of physicians indicated that opioid dose titration in patients with poor pain control and assessment of the cause and severity of pain were urgently needed knowledge for cancer pain management. A majority (65.0%) of physicians responded incorrectly (60.0% agreed and 5.0% had no opinion) that they would increase the dosage of a potent opioid and administer it every 4 h as needed (q4h PRN). Inadequate assessment of pain and pain management (63.0%), patients' reluctance to take opioids (62.2%), and inadequate staff knowledge of pain management (61.4%) were the three most frequently barriers to physicians’ pain management. Conclusions: Our results revealed that physician education in cancer pain management in China does not currently provide the necessary levels of knowledge and skills. Therefore, effective strategies and professional education are still needed to encourage physicians’ concern with, experience in, and knowledge of cancer pain management in China.

How well do medical oncologists manage chronic cancer pain? A national survey.

Cancer pain is usually managed by oncologists, occasionally with input from specialists in hospice and palliative medicine (PLM) or pain medicine (PMD). We evaluated the knowledge of cancer pain management in these three specialty groups. Eight vignettes depicting challenging scenarios of patients with poorly controlled pain were developed; each had five or six treatment choices. Respondents indicated choices likely to be safe and efficacious as "true" and choices likely to be unsafe or inefficacious as "false." Two questionnaires were created, each with four vignettes. Three anonymous mailings targeted geographically representative U.S. samples of 570 oncologists, 266 PMD specialists, and 280 PLM specialists, each randomly assigned one version of the questionnaire. Vignette scores were normalized to a 0-100 numeric rating scale (NRS); a score of 50 indicates that the number of correct choices equals the number of incorrect choices (consistent with guessing). Overall response rate was 49% (oncologists, 39%; PMD specialists, 48%; and PLM specialists, 70%). Average vignette score ranges were 53.2-66.5, 45.6-65.6, and 50.8-72.0 for oncologists, PMD specialists, and PLM specialists, respectively. Oncologists scored lower than PLM specialists on both questionnaires and lower than PMD specialists on one. On a 0-10 NRS, oncologists rated their ability to manage pain highly (median 7, with an interquartile range [IQR] of 5-8). Lower ratings were assigned to pain-related training in medical school (median 3, with an IQR of 2-5) and residency/fellowship (median 5, with an IQR of 4-7). Oncologists older than 46-47 years rated their training lower than younger oncologists. These data suggest that oncologists and other medical specialists who manage cancer pain have knowledge deficiencies in cancer pain management. These gaps help clarify the need for pain management education.

Commentary on "a nationwide survey of knowledge of and compliance with cancer pain management guidelines by korean physicians".

Kim et al. [1] have presented the results of a fascinating study that seems to show that “better knowledge of cancer pain management resulted in greater reduction of patient pain severity.”

Knowledge of cancer pain management among nurses in a Nigerian tertiary health institution

Background : Pain is a symptom of both physical and psychological disorder in patients. Pain may be acute or chronic. Chronic pain can also be the consequence of progressive diseases such as cancer. Cancer pain can be defined as a complex sensation that reflects both damage to the body and the body's response to the damage. Proper pain management is crucial in the overall care of patients. The doctor-patient ratio is still low in Nigeria according to World Health Organization (WHO) 2012, we have 1:3500 doctor-patient ratio as against the standard 1:600, but that of nurse-patient is better, 1:30 as against WHO standard of 1:6, however more nurses are needed to meet the need of the rising population of Nigeria. Incidence of cancer is rising worldwide and majority of the advanced cases occur in the developing countries like Nigeria. In order to uphold the standard of cancer pain management in our patients, active participation of the nurses is essential. More importantly all health professionals need to serve as advocates for adequate cancer pain control and should ensure that pain treatment is based on ethical principles and evidence-based standards. However nurses play a critical role in effective pain management because they have more contact time with patients in any healthcare setting. This vantage position gives the nurse a unique privilege to identify patients who have pain, assess the pain and its impact on the patients and their family members, thus initiate actions to manage the pain and evaluate the effectiveness of those actions. Aims and Objectives: This study is aimed at assessing the level of knowledge of cancer pain management among trained Nurses at the University College Hospital (UCH), Ibadan, Nigeria. Materials and Methods: Trained nurses who consented to take part in the study were tested using self-administered questionnaire. The questionnaires consisted of 3 major sections namely (a) Demography, (b) Pain assessment, (c) Cancer Pain management. Their individual level of knowledge of cancer pain management was thereafter assessed from their response to the questionnaires. Results: 119 N urses completed the questionnaire. 105 (88.24%) were double qualified, Registered Nurse (RN) and Registered Midwife (RM), while 10 (8.40%) had only RN certificate. Approximately 21 (18%) respondents had additional formal training in pain management. 100 (84%) respondents gave correct definition of pain and out of these, only 2 (2%) could give a good account on the management for cancer pain. 24 (20%) of the respondent could use Visual Analogue Scale (VAS) for pain assessment. Only 23 (19%) could state the relevance of opioids in cancer pain management. Conclusion: This study revealed inadequate knowledge in cancer pain management among the nurses. To achieve holistic care for cancer patients in all health care delivery centers, additional training in pain management is required.

Experience and Knowledge of Pain Management in Patients Receiving Outpatient Cancer Treatment: What Do Older Adults Really Know about Their Cancer Pain?

An individual's ability to effectively manage their cancer pain is influenced by knowledge and perceptions regarding the pain experience. While significance of the physician's knowledge of cancer pain management has been reported, much less is known how a patient's knowledge may influence their ability to optimally manage their pain. The purpose of this study is to determine the influence health and social factors have on the knowledge and experience of cancer pain among older adults. A prospective cross-sectional study of older Black and White patients presenting for outpatient cancer treatment. Participants were surveyed on questions assessing pain severity, knowledge and experience of pain, self-efficacy for pain treatment, satisfaction with pain treatment, and additional social, health, and demographic characteristics. A series of hierarchical regression models were specified to examine predictors of cancer pain knowledge and experience. Education, race, and trust were significant predictors of pain knowledge, whereas self-efficacy for pain, pain interference, and pain severity were indicators of the experience of cancer pain. Knowledge and experience of (cancer) pain are contingent upon a myriad of social and clinical factors that are not exclusive but rather coexisting determinants of health. Understanding older adults' knowledge of pain may begin to diminish the imparities in the diagnosis and treatment of pain among this growing diverse population of older adults. It may similarly allow for programs to be tailored to fit the specific needs of the patient in the treatment and management of their cancer pain.

The PRO-SELF Pain Control Program Improves Family Caregivers’ Knowledge of Cancer Pain Management

The majority of cancer treatment is provided in outpatient settings. Family caregivers' (FCs') knowledge and beliefs about pain and its management are critical components of effective care. This study's aim was to evaluate the efficacy of a psychoeducational intervention, compared with control, to increase FCs' knowledge of cancer pain management. Family caregivers of oncology outpatients were randomized together with the patients into the PRO-SELF Pain Control Program (n = 58) or a control group (n = 54). Family caregivers completed a demographic questionnaire and the Family Pain Questionnaire (FPQ) at the beginning and end of the study to assess their knowledge about pain and its management. The intervention consisted of nurse coaching, home visits, and phone calls that occurred over 6 weeks. One hundred twelve FCs (60% female) with a mean age of 63 (SD, 10.7) years participated. Compared with FCs in the control group, FCs in the PRO-SELF group had significantly higher knowledge scores on all of the single items on the FPQ, except for the item "cancer pain can be relieved," as well as for the total FPQ score. The use of a knowledge and attitude survey like the FPQ, as part of a psychoeducational intervention provides an effective foundation for FC education about cancer pain management. Oncology nurses can use FCs' responses to the FPQ to individualize teaching and spend more time on identified knowledge deficits. This individualized approach to FC education may save staff time and improve patient outcomes.

암병동 간호학생의 통증관리 지식과 호스피스 인식에 관한 연구

This study was to investigate the knowledge of cancer pain management and hospice awareness of nursing students in cancer ward. A total of 237 nursing students working at the cancer ward in Seoul and Gyeonggi Province from December 1st to 14th, 2012. The survey instrument used the 45-item scale for evaluating nursing students about knowledge of pain management and 23-item scale for evaluating hospice awareness. Data was statistically analyzed by SPSS Win 17.0 program, with descriptive analysis, t-test, pearson's correlation coefficient and ANOVA. The knowledge of pain management and hospice awareness showed statistically significant difference in the grade, religion, practice period of subjects. There was a significant difference between knowledge of pain management and hospice awareness. In order to understand cancer patient's pain, is required hospice education for forming a consensus. in addition, There is a need to increase the duration of the practice in order to have enough experience. that way, it is necessary to seek for expanding and promoting ways in order to hospice awareness.

Assessment of Cancer Pain Management Knowledge in Southwest China: A Survey of 259 Physicians from Small City and County Hospitals

Pain management is a critical issue in the care of cancer patients in China, especially in small city and county hospitals in southwest China. The study intended to determine Chinese physicians' competence in cancer pain management and to assess their opinions on barriers to optimal pain management. A questionnaire on pain management was given to 259 fellows after their general orientation meeting at a tertiary teaching hospital. The questionnaire was adapted from an earlier study by the Eastern Cooperative Oncology Group (ECOG). The majority of the fellows believed that 70% of cancer patients suffer pain. Nearly 90% (224/259) indicated that their training in cancer pain management was poor. The fellows stated that concern about morphine addiction was the primary reason they hesitated to prescribe opioids, and they identified inadequate assessment of cancer pain as the most significant barrier to optimal management of cancer pain. The study reflects to some extent the state of pain management in hospitals in southwest China. Medical students and physicians in China need improved pain management education.

Evaluation of knowledge of cancer pain management among medical practitioners in a low-resource setting

BackgroundSeveral factors considered to be barriers to cancer pain management have been reported in the past. The knowledge of cancer pain management may be a hindrance to the proper assessment and treatment of pain in cancer patients.Objective:This report presents an evaluation of the knowledge and practice of cancer pain management among medical practitioners in Ahmadu Bello University Teaching Hospital, Shika, Zaria.Methods:This report involves medical practitioners at the Ahmadu Bello University Teaching Hospital who are directly involved in the management of cancer patients. Information was obtained using a structured questionnaire, and the data were analyzed using SPSS (version 11.5).Results:The response rate to the questionnaire was 82%, with an age range of 23 to 50 years (mean age, 34.9), and the majority of actual respondents, 55 (67%), were male. Thirty-six (44%) strongly agreed that cancer patients require pain relief. Yet only 40% of the respondents routinely conducted pain assessments among cancer patients, while 51% only treated when patients complained of pain. Concerning the type of analgesic commonly used for cancer patients, 43% used weak opioids, 32% used NSAIDs, and only 20% used strong opioids. Seventy-five respondents (91.5%) had no formal training on pain management.Conclusion:The knowledge of pain management for cancer patients among medical personnel at the Ahmadu Bello University Teaching Hospital appears to be elementary. We recommend that formal training in the form of lectures, seminars, and workshops on cancer pain management should be part of continuing medical education in low-resource settings like the Ahmadu Bello University Teaching Hospital.

The Pro-Self© Pain Control Program Improves Patients' Knowledge of Cancer Pain Management

ContextInadequate knowledge is one barrier to effective cancer pain management. ObjectivesThis study's aim was to evaluate the effects of a psychoeducational intervention (the Norwegian version of the PRO-SELF© Pain Control Program) compared with a control group in increasing patients' knowledge of cancer pain management. MethodsAdult oncology outpatients with pain from bone metastasis of 2.5 or greater on a 0 to 10 numeric rating scale were randomized into the PRO-SELF (n=87) or control (n=92) groups. Patients completed a demographic questionnaire and the Pain Experience Scale (PES) at the beginning and end of the study to assess their knowledge and attitudes. The six-week intervention consisted of education, skills building, and nurse coaching. Mixed-model analyses with tests of a group×time interaction were done for each of the individual items and total PES scores to evaluate between-group differences in changes in knowledge over time. ResultsExcept for functional status, no differences were found between the PRO-SELF and control groups on any baseline demographic, clinical, or pain characteristics. Significant group×time interactions were found for all the single item and total PES scores. Compared with the control group, patients in the PRO-SELF group had significant increases in knowledge scores. ConclusionThe use of a knowledge and attitude survey, like the PES, as part of a psychoeducational intervention provides an effective foundation for patient education in cancer pain management. This individualized approach to education about pain management may save staff time and improve patient outcomes.

The knowledge and attitudes of cancer pain management of residents and nurses in university hospital in Daegu city, Korea

20701 Background: Pain is the most feared symptom in cancer patient. In general, pain is under-treated. Barriers to effective pain management of health care professionals includes inadequate training in pain management, poor assessment of pain, concern about side effect management, fear of addiction, low priority given to pain treatment, and inadequate reimbursement. The importance of education in improving treatment of pain is well recognized. Methods: The purpose of this study is to evaluate the knowledge and attitude of cancer pain management of residents and nurses in University hospital in Daegu city, and the Korean medical oncologists. A total of 48 residents and 51 registered nurses in Dongsan Medical Center, Keimyung University in Daegu and 183 nationwide medical oncologists were surveyed. Self-administered questionnaire covered 2 domains of 40 items; knowledge of general principles of cancer pain management and opioid use, were used. Results: With compare to medical oncologists, resident and nurses had statistically significant mis-knowledge in 5 items in general principles of cancer pain management (effective cancer pain management rate, VAS, the 5th vital sign, character of neuropathic pain, WHO ladder step) and 7 items about opioid use (addiction, tolerance, efficacy of strong opioids, knowledge about opioids, education rate, efficacy of parenteral opioids, ceiling effect). With compare to resident, nurses had statistically significant mis-knowledge in 4 items in general principles of cancer pain management (effective cancer pain management rate, poor assessment of health care professionals, VAS, WHO ladder step) and 14 items about opioid use (addiction, tolerance, effect on survival, opioid use to herself, incidence of side effect, knowledge about opioids, education rate, efficacy of parenteral opioids, patients’ refusal rate, seriousness of side effects, treatment of tolerance, by the clock, ceiling effect, reserves of opioid for intractable pain). Conclusions: The knowledge of cancer pain management of residents and especially nurses should be improved. No significant financial relationships to disclose.

Cancer Pain Management.

Mayo Graduate School of Medicine, Rochester, Minnesota. obray.jon@mayo.eduCancer Pain Management. By Michael J. Fisch, M.D., and Allen W. Burton, M.D. New York, McGraw-Hill, 2006. Pages: 319. Price: $99.00.Symptomatic treatment is important to patients with cancer, where treatment of pain can become as high a priority for the patient as treatment of the cancer itself. Multiple specialists often contribute to the care of a cancer patient, and their investigations into clinical care can lead to a diverse literature with respect to symptomatic management. It is to this end that the authors have sought to introduce a text where the diverse experience of multiple specialists is collected into one resource dedicated to the relief of suffering secondary to cancer pain.Chapters are focused on specific topics relevant to the treatment of cancer pain, with appropriate supporting references. The target audience is oncology specialists, but the editors note the benefit of the text for nononcology physicians and allied health professionals. The chapters are organized with appropriate titles and subtitles. Numerous figures and tables contribute to a clear, effective presentation. I appreciated the inclusion of chapters such as ethics in cancer pain management as well as skin pain and wound management.The book’s sections include general principles of cancer pain management, management of specific cancer pain syndromes, special issues in cancer pain management, and interventional techniques and other specialized approaches. Appendices address practical clinical subjects. Some chapters are brief and somewhat underdeveloped for most specialists who are engaged in the care of cancer pain patients. But overall, each chapter is well referenced, and when brief, the reader is able to identify a resource for a more in-depth review of the subject.Basic pharmacology is addressed in the first section, with a succinct but useful review of opioids and other analgesics such as nonsteroidal antiinflammatory agents. Tables provide general medical dosing guidelines. Studies addressing cardiovascular morbidity and cyclooxygenase 2–specific inhibitors are presented as well. A dedicated chapter addressing prevention and treatment of opioid side effects is helpful given the frequency of unwanted symptoms with opioid therapy. A chapter dedicated to the basic neurobiology of cancer pain is also included.The section on management of specific cancer pain syndromes includes chapters dedicated to bone pain, neuropathic pain, and wound management. These chapters provide a blend of basic science and clinical information. They are succinct, but well referenced. The chapter dedicated to the management of wounds is clinically beneficial, because this is a common serious complaint for patients. Special issues in cancer pain management are addressed in eight chapters, including a diverse mix of subjects from ethics to complementary and alternative medicine in oncology. A chapter dedicated to pediatric palliative care is included in this section, covering a broad number of topics, from pain assessment to treatment, including pharmacology and interventional techniques.I would have liked more detail included in the interventional technique chapters, specifically dealing with neuraxial infusions and neurolytic nerve blockade. These chapters are best described as an overview of interventional treatment options for cancer patients. As someone who has not trained in radiation oncology, I found the chapter on palliative radiation therapy techniques helpful.After noting the complexity of developing healthcare guidelines in the absence of a mature clinical literature, the editors have included appendices describing guidelines used in cancer care at the M. D. Anderson Cancer Center. These appendices offer practical suggestions in how to approach the application of procedural pain techniques in cancer patients as well as methadone dosing.Overall, this textbook is a good orientation to cancer pain management, which will be valuable to medical students and residents as well as fellows starting advanced training in pain medicine. It will also serve well the nonpain specialist looking to increase knowledge of cancer pain management. For the mature pain specialist, much of the information presented will likely be a review. I will look forward to future editions, which will likely be of increasing value to practicing pain specialists.Mayo Graduate School of Medicine, Rochester, Minnesota. obray.jon@mayo.edu

The use of a responder analysis to identify differences in patient outcomes following a self-care intervention to improve cancer pain management

Previously, we demonstrated, in a randomized clinical trial, the effectiveness of a psychoeducational intervention to decrease pain intensity scores and increase patients’ knowledge of cancer pain management with a sample of oncology patients with pain from bone metastasis. In the present study, we evaluated for changes in mood states (measured using the Profile of Mood States), quality of life (QOL; measured using the Medical Outcomes Study Short Form-36 (SF-36)), and pain’s level of interference with function (measured using the Brief Pain Inventory (BPI)) from baseline to the end of the intervention first between the intervention and the standard care groups and then within the intervention group based on the patients’ level of response to the intervention (i.e., patients were classified as non-responders, partial responders, or responders). No differences were found in any of these outcome measures between patients in the standard care and intervention groups. However, when patients in the intervention group were categorized using a responder analysis approach, significant differences in the various outcome measures were found among the three respondent groups. Differences in the physical and mental component summary scores on the SF-36 and the interference items on the BPI, among the three respondent groups, were not only statistically significant but also clinically significant. The use of responder analysis in analgesic trials may help to identify unique subgroups of patients and lead to the development of more effective psychoeducational interventions.