Pain Education Program Research Articles

Randomized clinical trial of an intensive nursing-based pain education program for cancer outpatients suffering from pain

IntroductionThe prevalence of pain in patients with cancer is still too high. Factors relating to ineffective pain treatment fall into three categories: the health care system, professional care providers, and patients. In patients, various barriers lead to noncompliance. Previous educational interventions have increased their knowledge of pain and decreased short-term pain levels. In this randomized controlled trial, the authors investigated how an intensive home-based education program given by nurses affected short-term and long-term pain levels.Materials and methodsOne hundred and twenty cancer patients were randomized to receive either the pain education program (PEP) or usual care. Pain, knowledge, quality of life, anxiety, and depression were measured at baseline and after 4 and 8 weeks. In the intervention group, effects on symptom levels were communicated to the treating physician.ResultsThe level of pain had decreased at 4 weeks, but not at 8 weeks. Significant decreases in pain only persisted in those patients with a high pain score at baseline. Knowledge of pain significantly increased in the intervention group. No correlation was found between increased pain knowledge and decreased pain levels.ConclusionsThe PEP given by nurses lowered pain intensity levels in cancer patients and increased their knowledge of pain. More attention should be paid to patient education and to communication between patients and health professionals regarding pain and pain management.

Effects of Pain Education Program on Pain Intensity, Pain Treatment Satisfaction, and Barriers in Turkish Cancer Patients

The purpose of this randomized controlled study was to investigate the effect of a pain education program (PEP) on pain intensity, patients' satisfaction with pain treatment, and patient-related barriers to pain management among Turkish patients with cancer. The study was conducted in a sample of 40 patients who were hospitalized for cancer and experiencing pain. The patients were equally randomized to either a PEP or a control group. The data were collected by means of the McGill Pain Questionnaire, the Numeric Rating Scale, and the Barrier Questionnaire–Revised. After the completion of the questionnaires at the first interview, patients in the PEP group received pain education using a pain educational booklet and an explanatory slide program that discussed the booklet's content with the patients. Patients in the control group received routine clinical care. The questionnaires were reapplied to the patients in both groups after 2, 4, and 8 weeks. Participation in a PEP was associated with decreased pain intensity scores for “present” and “least pain” during weeks 2, 4, and 8 ( p < .05). Similarly, there were significant differences between the groups with respect to weeks 2, 4, and 8 satisfaction with pain treatment ( p < .05). At the end of second week, the total BQ-r score decreased significantly in the PEP group from 2.12 to 1.29 compared with 2.30 to 2.28 in the control group ( p < .001). The findings suggest that the PEP decreases pain intensity, improves satisfaction with treatment, and decreases barriers about cancer pain management in cancer patients. Incorparation of PEP into the standard of care for cancer patients with pain may improve the quality of pain management.

Effects of a Pain Education Program on Nurses' Pain Knowledge, Attitudes and Pain Assessment Practices in China

The purpose of this study was to develop, implement, and evaluate the impact of a Pain Education Program (PEP) for nurses in China. The effects of PEP were measured in a quasi-experimental design. A total of 196 nurses who met the inclusion criteria from five nursing units in two teaching hospitals participated in the study. Randomization took place at the hospital level to select experimental and control groups. The research intervention was the PEP, which had two components: (1) to educate nurses about pain management and (2) to implement daily pain assessment by using the Changhai Pain Scale. The duration of PEP was five weeks and intervention methods included focused education, group activity, and individual instruction. After the baseline data were collected, PEP was implemented in the experimental group. The control group ( n = 90) received no intervention, and the experimental group ( n = 106) received six hours of focused education training. During the fourth and fifth weeks of the training program, the researcher and the faculty instructed nurses in five nursing units on how to use the Changhai Pain Scale to assess patients’ pain levels and demonstrated how to document pain condition in the nursing records. Nurses in both groups filled out a set of questionnaires, which included a background information form and the Nurses’ Knowledge and Attitude Survey form, before the PEP (T1), at one month after the PEP (T2), and at three months after the PEP (T3). Nurses in the experimental group who received the PEP had a significant improvement in their pain knowledge and attitudes. Their scores on the Nurses’ Knowledge and Attitude Survey increased from 15.67 at T1 to 26.13 at T2 and 35.14 at T3. The scores of nurses in the control group were unchanged (from 15.20 at T1 to 14.29 at T2 and 14.93 at T3, P > 0.05). In addition, experimental group nurses had an improvement in pain assessment. The percentage of nurses who correctly used the Changhai Pain Scale to assess patients’ pain intensity increased significantly after the PEP, and the increased usage of the assessment tool between experimental and control groups also shows a statistical difference in trend (χ 2=93.281, P < 0.001). The PEP has been demonstrated to be effective in improving nurses’ pain knowledge, attitudes, and assessment.

Educating Generalist Physicians about Chronic Pain: Live Experts and Online Education Can Provide Durable Benefits

Determine whether lectures by national experts and a publicly available online program with similar educational objectives can improve knowledge, attitudes, and beliefs (KAB) important to chronic pain management. A pretest-posttest randomized design with two active educational interventions in two different physician groups and a third physician group that received live education on a different topic to control for outside influences, including retesting effects, on our evaluation. A total of 136 community-based primary care physicians met eligibility criteria. All physicians attended the educational program to which they were assigned. Ninety-five physicians (70%) provided complete data for evaluation. Physician responses to a standardized 50-item pain management KAB survey before, immediately after, and 3 months following the interventions. The study groups and the 41 physicians not providing outcomes information were similar with respect to age, sex, race, percent engaged in primary care, and number of patients seen per week. Physician survey scores improved immediately following both pain education programs (live: 138.0-->150.6, P < 0.001; online: 143.6-->150.4, P = 0.007), but did not change appreciably in the control group (139.2-->142.5, P > 0.05). Findings persisted at 3 months. Satisfaction measures were high (4.00-4.72 on 1-5 scale) and not significantly different (P = 0.072-0.893) between groups. When used under similar conditions, national speakers and a publicly available online CME program were associated with improved pain management KAB in physicians. The benefits lasted for 3 months. These findings support the continued use of these pain education strategies.

Patient-Related Barriers to Effective Cancer Pain Management

Barriers to optimal cancer pain management exist among clinicians and patients and within the healthcare system. This article examines patient barriers to effective management of cancer pain. Unrelieved pain remains a major problem for patients with cancer and other diseases. Recommendations and guidelines for effective cancer pain management are widely available; however, patients continue to hold misconceptions about the use and effects of drugs commonly used to manage cancer pain. Although interventions designed to raise the awareness of patients seem to help in controlled research studies, much still needs to be done to address this problem. Researchers have advocated that control of cancer pain can be improved through patient education by helping patients have more control over their pain and by improving the patients' adherence to the scheduling of pain medications. Limited research efforts have been directed toward developing or evaluating the effectiveness of pain education programs that focus on patient-related barriers to pain management for patients with cancer.

Medication errors with opioids: Results from a national reporting system

Background: Errors may be more common and more likely to be harmful with opioids than with other medications, but little research has been conducted on these errors. Methods: The authors retrospectively analyzed MEDMARX®, an anonymous national medication error reporting database, and quantitatively described harmful opioid errors on inpatient units that did not involve devices such as patient-controlled analgesia. The authors compared patterns among opioids and qualitatively analyzed error descriptions to help explain the quantitative results. Results: The authors included 644 harmful errors from 222 facilities. Eighty-three percent caused only temporary harm; 60 percent were administration errors and 21 percent prescribing errors; and 23 percent caused underdosing and 52 percent overdosing. Morphine and hydromorphone had a significantly higher proportion of improper dose errors than other opioids (40 percent and 41 percent compared with 22 percent with meperidine). Hydromorphone errors were significantly more likely to be overdoses (78 percent vs 47 percent with other opioids). Omission errors were significantly more common with fentanyl patches (36 percent compared with 12 percent for other opioids). Wrong route errors were significantly more common with meperidine (given intravenously when prescribed as intramuscular, 34 percent vs 3 percent for morphine). Oxycodone errors were significantly more likely to be wrong drug errors (24 percent vs 11 percent for other opioids), often because of confusion between immediate- and sustained-release formulations. Conclusions: Reported opioid errors are usually associated with administration and prescribing and frequently cause uncontrolled pain as well as overdoses. These patterns of errors should be considered when using opioids and incorporated into pain guidelines, education, and quality improvement programs.

Medication errors with opioids: Results from a national reporting system

Errors may be more common and more likely to be harmful with opioids than with other medications, but little research has been conducted on these errors. The authors retrospectively analyzed MEDMARX, an anonymous national medication error reporting database, and quantitatively described harmful opioid errors on inpatient units that did not involve devices such as patient-controlled analgesia. The authors compared patterns among opioids and qualitatively analyzed error descriptions to help explain the quantitative results. The authors included 644 harmful errors from 222 facilities. Eighty-three percent caused only temporary harm; 60 percent were administration errors and 21 percent prescribing errors; and 23 percent caused underdosing and 52 percent overdosing. Morphine and hydromorphone had a significantly higher proportion of improper dose errors than other opioids (40 percent and 41 percent compared with 22 percent with meperidine). Hydromorp hone errors were significantly more likely to be overdoses (78 percent vs 47 percent with other opioids). Omission errors were significantly more common with fentanyl patches (36 percent compared with 12 percent for other opioids). Wrong route errors were significantly more common with meperidine (given intravenously when prescribed as intramuscular, 34 percent vs 3 percent for morphine). Oxycodone errors were significantly more likely to be wrong drug errors (24 percent vs. 11 percent for other opioids), often because of confusion between immediate- and sustained-release formulations. Reported opioid errors are usually associated with administration and prescribing and frequently cause uncontrolled pain as well as overdoses. These patterns of errors should be considered when using opioids and incorporated into pain guidelines, education, and quality improvement programs.

Student Nurses' Knowledge, Attitudes, and Self-Efficacy of Children's Pain Management: Evaluation of an Education Program in Taiwan

The purpose of this study was to examine the effectiveness of a pediatric pain education program (PPEP) for student nurses. The sample consisted of 181 licensed student nurses who were enrolled in a nursing school in Taiwan. Student nurses attended a 4-hour PPEP that involved case scenario discussion, video, and lecture. Data were collected by an extensive questionnaire that assessed student nurses' knowledge of, attitudes toward, and self-efficacy in pediatric pain assessment and pharmacological and nonpharmacological pain management. The results demonstrated that student nurses gained significant knowledge of pediatric pain, expressed more appropriate attitudes, and reported greater self-efficacy in children's pain management after attending PPEP. Their knowledge of analgesic pharmacotherapy did not significantly improve. These results suggest that PPEP should be integrated into pediatric nursing curricula to enhance knowledge and skills regarding children's pain management during the early stage of a nursing career.

Long-term effectiveness of a patient and family pain education program on overcoming barriers to management of cancer pain

The purpose of this research was to investigate the effectiveness of a patient and family pain education program on reducing cancer patients’ and their families’ barriers to (i.e., concerns or misconceptions about) cancer pain management, on increasing patients’ adherence to a prescribed analgesic regimen, and on decreasing pain intensity and pain interference with daily life. An experimental and longitudinal design was used. The experimental group consisted of 31 pairs of cancer outpatients and their family carers, while the control group consisted of 30 patient–family pairs ( N = 122). Patients and their family carers in the experimental group simultaneously received a pain management education program. Both groups had pretest data collection and after-test follow-ups on the second and fourth weeks at the outpatient clinics. Comparisons between those two groups were made using the Generalized Estimating Equations (GEE) method. Results revealed that at both the second and fourth weeks, patients and family carers in the experimental group showed a significantly greater reduction in barrier scores than did patients and family carers in the control group. At the second and fourth weeks, patients in the experimental group reported significantly better adherence to a scheduled analgesic regimen than did patients in the control group. In the fourth week, patients in the experimental group reported significantly lower levels of worst pain intensity and pain interference than did patients in the control group. This research provides evidence of the effectiveness of a patient and family pain education program.

Prediction of outcome: Post-operative pain intensity reported by patients, family members, and nurses

It is well recognized that assessing and treating pain minimizes its harmful effects. Although nurses have become more skilled at pain assessment, many still do not use all available sources of information when making treatment decisions. It is unclear if nurses are accurate in their assessment of patients' pain or if the family's evaluation of pain is incorporated into the plan. This study explored whether there are differences in the perception and rating of a post-surgical patient's pain intensity among patients, family members, and nurses, using a verbal analogue scale. Perceptions of the patient's pain were not significantly different between patients and family, nor between patients and nurses. However, perceptions were different between the family and the nurses, suggesting that family members overestimate and nurses underestimate pain. This may perpetuate pain control issues in the hospital and post-discharge, and have implications for the content of pain education programs.

Development of a pain management programme for family carers of advanced cancer patients.

This article reports the first phase of a three-phase study to develop and test a pain education programme for family carers of patients with advanced cancer. The purpose of this phase was to develop the pain education programme. Interviews were conducted with 19 family carers to elicit their perceptions about the components, content, amount and timing of an educational programme that might be useful in educating them about pain management. Interviews were taped, transcribed and content analysed. Family carers reported knowledge deficits regarding pain, medications, comfort therapies and general comfort measures. Strategies for learning were described. Findings from these interviews together with results published in the literature were structured into a formal pain management programme. This programme has been pilot tested and evaluated using a randomized clinical trial.

Improving Cancer Pain Management Through Patient and Family Education

The purpose of this study was to determine if continued access to information following a baseline pain education program would increase knowledge and positive beliefs about cancer pain management, thus resulting in improved pain control during a 6-month follow-up period. Patients with cancer-related pain and their primary caregivers received a brief pain education program, and were then randomized into one of three information groups: a) usual care, b) pain hot line, and c) weekly provider-initiated follow-up calls for 1 month post-education. Sixty-four patients and their primary caregivers were recruited. Both patients and caregivers showed an improvement in knowledge and beliefs after the baseline pain education program. Continued access to pain information with either the pain hot line or provider-initiated weekly follow-up calls did not affect long-term outcomes of pain intensity, interference because of pain, adequacy of analgesics used, or pain relief. In addition, long-term outcomes did not differ between patients who had improvement and those who showed decline in knowledge and beliefs pre–post education. These findings suggest that a brief pain education program can improve knowledge and beliefs of both patient and primary caregiver. Continued access to pain related information using either a patient- or provider-initiated format did not affect long-term pain outcomes.

This issue of JAN

This issue of <i>JAN</i>

Life-extending therapies among patients with advanced cancer: patients' levels of pain and family caregivers' concerns about pain relief.

The purposes of this article are to explore the extent to which oncology unit patients with advanced cancer in Taiwan receive life-extending therapies and to examine the relationship of care goals (curative vs palliative) to levels of pain and family caregivers' concerns about pain reporting and analgesic administration. Forty pairs of patients with advanced cancer and their family caregivers (N = 80) were recruited from inpatient oncology units in Taiwan. Of these patients, 53% were receiving chemotherapy or radiotherapy for life-extending or curative reasons as opposed to palliative goals. Patients with advanced cancer who were receiving life-extending therapies experienced lower levels of pain intensity than did those who were not receiving life-extending therapies. Moreover, Taiwanese family caregivers of patients with advanced cancer had concerns about reporting pain and administering analgesics regardless of whether the patient was receiving life-extending therapies. However, the family caregivers whose patients were receiving life-extending therapies were less concerned about using analgesics than were those caregivers whose patients were not receiving life-extending therapies. Finally, family caregivers' concerns about pain management as measured by the Barriers Questionnaire-Taiwan (BQT) form were related to family caregivers' reluctance to report their patients' pain. Implications of this study are discussed in terms of palliative care and pain educational programs.

Improving the quality of pain treatment by a tailored pain education programme for cancer patients in chronic pain

Educational interventions, aiming to increase patients' knowledge and attitude regarding pain, can affect pain treatment. The purpose of this study was to evaluate the effects of a Pain Education Programme (PEP), on adequacy of pain treatment, and to describe characteristics predicting change in adequacy. The PEP consists of a multi-method approach in which patients are educated about the basic principles regarding pain, instructed how to report pain in a pain diary, how to communicate about pain, and how to contact healthcare providers. The effects of the PEP were evaluated taking into consideration the lack of well-established outcome measures to evaluate adequacy of pain treatment, the lack of long-term follow-up, and the influence of missing data.A prospective, randomized study was utilized in which 313 chronic cancer patients were followed-up until 8 weeks postdischarge. Adequacy of pain treatment was evaluated by means of the Amsterdam Pain Management Index (APMI), consisting of an integrated score of patients' Present Pain Intensity, Average Pain Intensity, and Worst Pain Intensity, corrected for patients' Tolerable Present Pain, with the analgesics used by the patient.At pretest, 60% of the patients in the hospital were treated inadequately for their pain. Postdischarge, the control group patients were significantly more inadequately treated at 2 weeks after discharge (56%vs 41%), at 4 weeks after discharge (62%vs 42%) and at 8 weeks after discharge (57%vs 51%) than the intervention group patients. While the level of inadequacy in the control groups remained relatively stable at all assessment points, a slight increase in the percentage of patients being treated inadequately was found in the intervention group patients over time. A beneficial effect of the PEP was found for patients both with and without district nursing. Variables predicting an improvement in adequacy of pain treatment consisted of the PEP, the APMI score at baseline, patients' level of physical functioning, patients' level of social functioning, the extent of adherence to pain medication, patients' pain knowledge, and the amount of analgesics used.These findings suggest that quality of pain treatment in cancer patients with chronic pain can be enhanced by educating patients about pain and improving active participation in their own pain treatment. The benefit from the PEP, however, decreases slightly over time, pointing at a need for ongoing education.

The pain education program: results of an implementation process on nursing wards

The pain education program: results of an implementation process on nursing wards

Improving the quality of pain treatment by a tailored pain education program for cancer patients in chronic pain

Improving the quality of pain treatment by a tailored pain education program for cancer patients in chronic pain

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

There is no ‘gold standard’ to assess the adequacy of pain treatment in cancer patients. The purpose of the study is to explore the Amsterdam Pain Management Index, a newly designed measure to evaluate the adequacy of cancer pain treatment, and to compare it with eight frequently used outcome measures. The Amsterdam Pain Management Index compares patients’ Present Pain Intensity, Average Pain Intensity, and Worst Pain Intensity with a composite score of analgesics used, while correcting for what a patient considers as a tolerable level of pain. The eight frequently used outcome measure consisted of three Pain Intensity Markers, the Pain Relief Scale, the Patient Satisfaction Scale, and three Pain Management Indexes. In a randomized controlled trial, 313 cancer patients with a pain duration of at least 1 month were included and followed-up three times until 2 months postdischarge at home. The experimental group received a Pain Education Program, consisting of tailored pain information and instruction. Results showed that, except for the three Pain Management Indexes, the agreement between the measures was very low to moderate. The test of known-groups comparisons and equivalence between groups indicated that the Amsterdam Pain Management Index showed promising results. The Pain Intensity Markers and the Pain Relief Scale were limited in discriminating between groups, while the Patient Satisfaction Scale showed no differences between patient groups. Although it was possible for the Pain Management Indexes to distinguish between patient groups, the differences were not in the expected direction. The ability of the outcome measures to detect changes over time was clearly demonstrated by all outcome measures. Effects of the intervention were only found for the Amsterdam Pain Management Index and patients’ Substantial Worst Pain score. Although support was provided for the use of the Amsterdam Pain Management Index, more research is warranted.

Controlled Substances and Pain Management: Changes in Knowledge and Attitudes of State Medical Regulators

Physicians report that concern about regulatory investigation negatively influences their prescribing of opioid analgesics. The views of medical regulators about the legality of prescribing controlled substances for pain management were studied in 1991. However, little is known about whether these views have changed in light of increased emphasis on pain management and educational programs for state medical boards. Two studies that examined this issue are described. In Study 1, a 1997 survey of state medical board members was compared to results obtained in 1991 to evaluate differences in knowledge and perceptions about opioid analgesics. Important changes were observed over time, particularly regarding characteristics of “addiction” and the legality of prolonged prescribing of opioids. For Study 2, a longitudinal survey was conducted of medical board members who participated in five workshops about pain management and regulatory policy. Results revealed significant and sustained changes in attitudes about the incidence of iatrogenic addiction when using opioids to treat pain, the analgesic and side-effect properties of opioids, and the perceived legality of prescribing opioids. Recommendations for reducing concerns about regulatory scrutiny are presented, including the need for a more intensive education program, increasing the rate of adoption of new state medical board policies, and improving communication between regulators and clinicians.

Feldenkrais Intervention in Fibromyalgia Patients: A Pilot Study

Objectives: To evaluate the effect of the Feldenkrais intervention, in fibromyalgia patients.Methods: Twenty fibromyalgia patients started Feldenkrais intervention done as one individual and two group sessions weekly for 15 weeks. Nineteen started a group-based pain education program followed by a pool program. Test and self-report questionnaires were administered at the start, at six month follow up, and at the end of intervention.Results: After the Feldenkrais intervention improvement in balance and trends to better lower extremity muscle function were shown, but the improvements were not maintained.Conclusions: No sustained benefit of the Feldenkrais intervention compared to a pool program was seen. Methodological problems are discussed.