Pain Management Index Research Articles

Trajectories of Pain and Analgesics in Oncology Outpatients With Metastatic Bone Pain

A large proportion of oncology outpatients with bone metastasis report unrelieved pain that significantly interferes with daily functioning and quality of life. However, little is known about the longitudinal pattern of pain intensity and analgesic prescriptions or use. Moreover, despite considerable advantages, the use of sophisticated statistical techniques, such as hierarchical linear modeling (HLM) has not been applied to the study of pain and analgesic outcomes. In a prospective longitudinal study, HLM was used to explore predictors of pain intensity and analgesic prescription and intake at the time of enrollment into the study (intercept) and over the course of 6 weeks (trajectory) in a sample of oncology outpatients with bone metastasis who received standard care for pain. In addition to corroborating known predictors of pain intensity, previously unrecognized variables were found that appear to affect both pain and analgesic outcomes. Importantly, some of the predictors of the trajectories of pain intensity and analgesic use (ie, pain-related distress and Pain Management Index (PMI) scores) are particularly amenable to interventions. Findings from this study suggest that sophisticated statistical modeling can be used in pain research to identify individual risk factors and propose novel targets that can be used to improve pain management in oncology outpatients with bone metastasis. Findings from this study suggest that a large amount of inter-individual variability exists in patients' experiences with cancer pain and analgesic use. Future studies need to elucidate the mechanisms that underlie these differences.

Adequacy of pain management in HIV-positive patients

AbstractBackground: A growing body of literature supports the view that people infected with HIV suffer significant pain and that pain is not well recognised or managed by health care professionals. This study investigated the prevalence, severity, recognition and management of pain in adult patients with HIV infection in a South African hospital setting.Methods: The Brief Pain Inventory (BPI) (short form) questionnaire was administered to 100 consecutive, consenting HIVpositive patients admitted to an urban district-level hospital in KwaZulu-Natal. Convenience sampling was employed with participants recruited on consecutive days. Data sources comprised patient interviews and review of hospital records. A Pain Management Index derived from the BPI was calculated to establish the adequacy of pain management. Descriptive statistics were tabulated for the recognition of pain, pain severity and appropriateness of analgesia. Correlation analyses were used to assess the association between pain and daily life.R...

Analysis of pain status and pain management of home ⁃based advanced cancer patients with pain

Objective To evaluate the severity of cancer⁃related pain and the adequacy of pain management in home⁃based advanced cancer patients with pain, and to examine whether the awareness of cancer diagnosis affected their pain severity. Methods A cross ⁃ sectional study was completed with a sample of 98 home ⁃ based advanced cancer patients with pain who first visited the Hospice of the First Affiliated Hospital of Chongqing Medical University from December, 2009 to June, 2010. Pain severity was measured by using the Brief Pain Inventory (BPI). Descriptive analysis was conducted for demographic and clinical data, t⁃test was performed to compare pain severity between 2 groups, those who knew their cancer diagnosis and those did not. Results Of 98 patients, 56.12% (55/98) were male and the mean age of patients was (61.08 ± 11.67) years old, 79.59% (78/98) of the patients reported moderate to severe pain during the past 24 h. 11.22% (11/98) of the patients were not receiving any analgesics at the time of the survey. There were 19.39% (19/98) patients receiving non⁃steroid anti⁃inflammatory drug (NSAID), 35.71% (35/98) receiving weak opioids and 33.67% (33/98) receiving strong opioids, and 39.80% (39/98) had a negative Pain Management Index (PMI). There were 46.94% (46/98) patients did not know their cancer diagnosis. No statistically significant differences in cancer pain severity were seen between 2 groups, those who knew their cancer diagnosis and those did not (P > 0.05, for all). Conclusion This study provides a representative view of pain status of home⁃based advanced cancer patients in China. The findings suggest that cancer pain management is insufficient in home⁃based advanced cancer with pain. Intensive analgesia should be given to these patients. Many factors may influence the pain severity and reduction, but honest disclosure of the cancer diagnosis to patients does not affect their severity of cancer pain. DOI：10.3969/j.issn.1672-6731.2010.06.010

Impact of setting of care on pain management in patients with cancer: a multicentre cross-sectional study

Background: No study has so far addressed whether differences do exist in the management of cancer-related pain in patients admitted to oncology and non-oncology settings.Patients and methods: A multicentre cross-sectional study in 48 Italian hospitals has enrolled 819 patients receiving analgesic therapy for cancer-related pain. Demographics and clinical and analgesic therapy information have been prospectively collected by standardized forms. Adequacy of pain management has been evaluated by the Pain Management Index (PMI).Results: Differences in the analgesic drug administration according to settings of care have been evident, non-opioids more frequently being administered in non-oncology units (19.6% versus 7.0%; P < 0.0001), while strong opioids are more frequently used in the oncology units (69.5% versus 51.9%; P < 0.0001). The number of patients receiving inadequate therapy (PMI < 0) has lowered in oncology compared with non-oncology units (11.3% versus 18.8%; P = 0.0024). Results of multiple logistic regression analysis have shown that the admission to non-oncology setting [odds ratio (OR) = 1.75, 95% confidence interval (CI) = 1.15–2.67; P = 0.0096] and the absence of metastatic disease (OR = 1.60, 95% CI = 1.04–2.44; P = 0.0317) were independent factors associated with an increased risk of receiving an inadequate analgesic therapy.Conclusion: Oncology wards provide the most adequate standard of analgesic therapy for cancer-related pain.

Change in Cancer Pain Management in Korea Between 2001 and 2006: Results of Two Nationwide Surveys

In Korea, many health care professionals have shown increased concern about the management of cancer pain. Five years after a pain management guideline was distributed to Korean physicians, the Korean Society of Hospice and Palliative Care evaluated the change in cancer pain management. The period evaluated was between 2001 and 2006. We did a prospective, cross-sectional cancer pain survey on the change of the pain prevalence and pain intensity, its impact on daily activities and the adequacy of pain management between 2001 and 2006. Overall, 7565 patients were enrolled from 72 cancer hospitals in the 2001 cancer pain survey and 7245 patients were enrolled from 63 cancer hospitals in the 2006 cancer pain survey. The overall prevalence of cancer pain and the percentage of patients reporting a negative pain management index were significantly decreased in the 2006 cancer pain survey compared with the 2001 cancer pain survey (44.9% vs. 52.1%, P<0.0001 and 41.6% vs. 45.0%, respectively, P=0.0005). However, in 2006, physicians did not prescribe analgesics to 25.8% of the patients with severe pain and they did not adjust the prescribed analgesics properly in 47.4% of the patients with severe pain. Some improvement in cancer pain management was noted during the five years between 2001 and 2006. However, all of the physicians who care for cancer patients should pay more attention to cancer pain management, and aneducational program for cancer pain management should be distributed to allof the physicians who care for cancer patients.

A Randomized Controlled Trial of a Standardized Educational Intervention for Patients with Cancer Pain

Published literature has not defined the effectiveness of standardized educational tools that can be self-administered in the general oncology population with pain. We sought to determine if an educational intervention consisting of a video and/or booklet for adults with cancer pain could improve knowledge and attitudes about cancer pain management, pain levels, pain interference, anxiety, quality of life, and analgesic use. Eligible participants had advanced cancer, a pain score >/=2 of 10 in the last week, English proficiency, an estimated prognosis of more than one month, and were receiving outpatient cancer treatment at participating hospitals. Participants completed baseline assessments and then were randomly allocated to receive a booklet, a video, both, or neither, in addition to standard care. Outcome measures at two and four weeks included the Barriers Questionnaire (BQ), Brief Pain Inventory, Global Quality of Life Scale, and Hospital Anxiety and Depression Scale. Adequacy of analgesia and severity of pain were assessed with the Pain Management Index and a daily pain diary. One hundred fifty-eight participants were recruited from 21 sites over 42 months. Baseline mean barriers scores were lower than reported in previous Australian studies at 1.33 (standard deviation: 0.92). Mean average pain and worst pain scores improved significantly in patients receiving both the video and booklet by 1.17 (standard error [SE]: 0.51, P=0.02) and 1.12 (SE: 0.57, P=0.05), respectively, on a 0-10 scale. The addiction subscale of the BQ score was improved by 0.44 (SE: 0.19) for participants receiving any part of the intervention (P=0.03). Provision of a video and/or booklet for people with cancer pain was a feasible and effective adjunct to the management of cancer pain.

Clinical Governance Benchmarking Issues in Oncology: Aggressiveness of Cancer Care and Consumption of Strong Opioids. A Single-Center Experience on Measurement of Quality of Care

The aggressiveness of cancer care near the end of life and the consumption of opioids are potential indicators of quality of care in palliative and end-of-life settings. The purpose of this article is to present a retrospective analysis regarding these themes and the adopted procedures to improve quality of care. We evaluated all cancer patients treated and deceased during 2008 and considered those who died and received any antiblastic therapy within 14 and 30 days prior to death. Moreover, we evaluated the annual consumption of pure opioids during 2007 and 2008 in our inpatient clinic. We found that 5% and 9% of all treated patients were still receiving antiblastic treatment near the end of life within respectively 14 and 30 days prior to death (respectively 29.6% and 51.5% of deceased patients). All but 2 patients died from progressive disease, one patient died from acute myocardial infarction during chemotherapy, and one of severe sepsis after chemotherapy for non-Hodgkin lymphoma. As regards the annual consumption of strong opioids, there was a 179% increase in the use of morphine-equivalent doses of oral long-acting opioids (+228% for oxycodone) after the introduction of daily pain measurement through a numerical rating scale. To reduce the administration of chemotherapy near the end of life, we introduced the palliative prognostic score, to be administered to all advanced cancer patients with performance status of at least 2. To evaluate the effectiveness of analgesics and to reduce the cases of undertreatment of cancer pain, we adopted, in addition to the numerical rating scale, Cleeland's Pain Management Index. We are convinced that attempts to improve the quality of care can be achieved by the collaboration of all health professionals, patients and care givers.

A Multicenter Assessment of the Adequacy of Cancer Pain Treatment Using the Pain Management Index

Determine adequacy of management of pain secondary to bone metastases by physicians referring to specialized outpatient palliative radiotherapy (RT) clinics in Canada; compare geographic differences in adequacy of pain management and pain severity between these cohorts; compare results with published international literature. Prospectively collected data from three participating centers were used to calculate the Pain Management Index (PMI) by subtracting the patient-rated pain score at time of initial clinic visit from the analgesic score. Scores were 0, 1, 2, and 3 when patients reported no pain (0), mild (1-4), moderate (5-6), or severe pain (7-10), respectively, on the Edmonton Symptom Assessment System or Brief Pain Inventory. Analgesic scores of 0, 1, 2, and 3 were assigned for no pain medication, nonopioids, weak opioids, and strong opioids respectively. A negative PMI suggests inadequate pain management. Overall incidence of negative PMI and moderate to severe pain was 25.1% and 70.9% respectively for 2011 patients. Comparing the three participating centers, the incidence of negative PMI was 31.0%, 20.0%, and 16.8% (p < 0.0001), and severe pain was 55.5%, 48.2% and 43.4% (p < 0.0001), these correlated with a negative PMI. Patients referred to our clinics were less likely to be undertreated for their pain when compared to study results from international countries. Geographic differences in adequacy of analgesic management for painful bone metastases exist between Canadian specialized outpatient palliative RT clinics and between centers globally. Investigating reasons for these differences may provide insight into solutions to improve quality of life for these patients.

The Adequacy of Chronic Pain Management Prior to Presenting at a Tertiary Care Pain Center: The Role of Patient Socio-Demographic Characteristics

The Pain Management Index (PMI) is used to assess pain medication adequacy in black and white chronic pain patients (18-50 years) at referral to tertiary pain care. Using WHO guidelines for pain treatment, PMI was calculated from pain severity and drug analgesic potency. From 183 patients recruited, 128 provided treatment information for analyses (53% white, 60% female). Most (51.6%) had adequate PMI. Blacks were prescribed fewer pain medications (P = .03); fewer women had adequate medication strength (P = .04). In hierarchical regression, PMI was predicted at entry by female gender, lower MPI, higher affective MPQ, and a gender X age interaction. Younger men experienced better pain management, reducing toward the PMI level of women by age 50. In the final block, black race, being married, affective pain, and gender X age were associated with higher PMI, female gender and being employed were associated with lower PMI. Women, particularly younger women, were at higher risk for inadequate pain management in a primary care environment. These results support variability in chronic pain care and the need for research focusing on whether these disparities persist with specialized pain care. Most people with pain receive initial care in a primary care setting. This study examining the adequacy of pain management prior to specialty pain care showed blacks and women had less adequate pain care at referral. These results suggest the need for interventions and education in the primary care arena to improve pain care.

Retrospective Assessment of Cancer Pain Management in an Outpatient Palliative Radiotherapy Clinic Using the Pain Management Index

The Pain Management Index (PMI) is a simple index linking the usual severity of cancer pain with the category of medication prescribed to treat it. Medication categories are derived from the World Health Organization's "analgesic ladder" approach to cancer pain, and the PMI is an indicator of the extent to which the medication prescribed corresponds to the recommended categories for mild, moderate, and severe pain. The aim of this study was to assess prevalence of inadequate pain management in an outpatient palliative radiotherapy clinic using the PMI. All patients with bone metastases referred for palliative radiotherapy from 1999 to 2006 were retrospectively analyzed for patient-rated pain scores (0-10 scale) and analgesic consumption. Pain scores were assigned 0, 1, 2, and 3 when patients reported no pain (0), mild (1-4), moderate (5-6), or severe pain (7-10), respectively. Analgesic scores of 0, 1, 2, and 3 were assigned when patients were prescribed no pain medication, nonopioids, "weak" opioids, and "strong" opioids, respectively. The PMI score was calculated by subtracting the pain score from the analgesic score. A negative PMI score was considered an indicator of potentially inadequate pain management by the prescriber. Descriptive statistics, Pearson's r correlation, and univariate and multivariate logistic regression analysis were used to determine the relationship of PMI over time, and the relationship with predictive factors. One thousand patients were included from January 1999 to December 2006. A negative PMI was calculated for 25.8% of patients at initial consultation. Prevalence of negative PMI significantly increased over years (P<0.0001). Higher Karnofsky Performance Status (P<0.0001) and breast primary cancer site (P<0.0001) were significantly associated with negative PMI after adjusting for year variable. Despite publication of numerous cancer pain management guidelines, undermedication appears to be a persistent problem for patients with painful bone metastases referred for radiotherapy.

Assessment of Cancer Pain Management using the Pain Management Index: A Canadian Multi-centered Investigation

To determine the frequency of undertreatment of pain due to bone metastases using the pain management index (PMI) within dedicated palliative radiotherapy (RT) clinics in Canada, and to determine similarities and differences in trends.

Age-Related Patterns in Adaptation to Cancer Pain: A Mixed-Method Study

Although older people make up the majority of cancer patients, little is known about aging and cancer pain. The objective of this study was to explore age-related patterns in adaptation to chronic cancer-related pain in younger and older patients. A mixed-method study combining quantitative measures with individual semi-structured interviews. Quantitative measures included the Brief Pain Inventory, Pain Management Index, Charlson Comorbidity Index, and Karnofsky Performance Status. Two outpatient clinics (Palliative Care and Cancer Pain service) in an academic cancer hospital. Fifteen younger (average age: 48.9 +/- 4.9 years old) and 17 older (average age: 72.4 +/- 9.2 years old) people with cancer-related pain. Two age-related adaptation outcomes emerged from the interviews: "Waiting to live" and "Living despite pain." Younger patients were more likely than older patients to be "Waiting to live." They felt that complete pain relief was necessary before their lives could move forward and reported feeling out of control, angry, and unable to accept their pain. Marital strain was common. "Living despite pain" was more frequent among older than younger patients. These patients accepted pain as an inevitable part of cancer, pursued life goals, and modified activities to maximize engagement. Marital growth was common. Older and younger cancer patients described different adaptations to cancer pain despite reporting comparable pain intensity and interference. Older patients adapted by employing accommodative strategies. Younger patients were less likely to use these strategies and struggled with accepting the losses associated with cancer pain. These findings may guide future research into age-related patterns in cancer pain and the development of psychosocial interventions tailored to patients' life stage challenges.

Pattern and quality of care of cancer pain management. Results from the Cancer Pain Outcome Research Study Group

Most patients with advanced or metastatic cancer experience pain and despite several guidelines, undertreatment is well documented. A multicenter, open-label, prospective, non-randomised study was launched in Italy in 2006 to evaluate the epidemiology, patterns and quality of pain care of cancer patients. To assess the adequacy of analgesic care, we used a standardised measure, the pain management index (PMI), that compares the most potent analgesic prescribed for a patient with the reported level of the worst pain of that patient together with a selected list of clinical indicators. A total of 110 centres recruited 1801 valid cases. 61% of cases were received a WHO-level III opioid; 25.3% were classified as potentially undertreated, with wide variation (9.8–55.3%) according to the variables describing patients, centres and pattern of care. After adjustment with a multivariable logistic regression model, type of recruiting centre, receiving adjuvant therapy or not and type of patient recruited (new or already on follow-up) had a significant association with undertreatment. Non-compliance with the predefined set of clinical indicators was generally high, ranging from 41 to 76%. Despite intrinsic limitations of the PMI that may be considered as an indicator of the poor quality of cancer pain care, results suggest that the recourse to WHO third-level drugs still seems delayed in a substantial percentage of patients. This delay is probably related to several factors affecting practice in participating centres and suggests that the quality of cancer pain management in Italy deserves specific attention and interventions aimed at improving patients’ outcomes.

Racially Based Disparities in Pain Management: Something Old, Something New, But What to Do?

In this issue of Pain Medicine , Montague and Green report data that add to a growing body of evidence of disparities in pain management correlated with race and ethnicity. In their study of breakthrough pain in 96 adults with advanced-stage solid neoplasms (breast, lung, prostate, and colorectal) and myeloma, they observed that self-identified “minorities” reported statistically significantly greater baseline pain severity and greater severity for BTP than whites did [1]. Other characteristics of pain and function, such as duration, quality, or location of breakthrough flares, and health-related quality of life scores were not statistically different between minorities and whites but trended to be worse in minorities. In one sense, this is the same, old story. As Montague and Green note, using the same measure that they used in this study—the Pain Management Index—Cleeland et al. reported in a serious of studies over more than 10 years that minorities (African Americans and Hispanics) were at higher risk for poorer cancer pain management than whites [2,3]. The new findings in this study extend the reporting of disparate outcomes in cancer pain management to the realm of breakthrough pain. In addition, the authors reported an interesting negative finding: there were no significant ethnic differences in patient coping as measured by the John Henryism Acting Coping Scale (JHACS), although men had higher scores than women. The JHACS scale is named for a mythical figure in African American culture who tried to succeed in work and life by controlling behavioral stressors through a single-minded coping strategy of hard work …

Adequacy Assessment of Oxycodone/Paracetamol (Acetaminophen) in Multimodal Chronic Pain

Multimodal pain is comprised of nociceptive/inflammatory and neuropathic components. Pharmacological pain therapies from different classes provide pain relief using different mechanistic actions; often a combination of such therapies provides more effective pain relief than monotherapy. To assess whether pain management is adequate requires a comprehensive pain scoring system. To evaluate the adequacy of a low-dose combination of oxycodone and paracetamol (acetaminophen) in patients with multimodal, chronic, non-malignant pain using the Pain Management Index (PMI). During this prospective, observational study, consecutive patients were classified according to the presence of prevalent osteoarticular pain (group A, n = 78) or prevalent neuropathic pain (group B, n = 72). Existing pain-relief medications were discontinued and both groups received oxycodone 5 mg and paracetamol 325 mg up to 8 hourly for a planned duration of >/= 6 weeks. Patients in group B who were receiving gabapentin continued this treatment up to a maximum daily dosage of 2400 mg during the observation period. Pain intensity was evaluated using a visual analogue scale (VAS from 0 to 10). Functional limitation for patients in group A was evaluated using the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). The intensities of dynamic allodynia and hyperalgesia in patients in group B were evaluated by a VAS. Results from the WOMAC, dynamic allodynia, and hyperalgesia assessments were evaluated using the PMI. In group A, 64.3% of patients showed improvements in pain symptoms after 15 days of treatment in the WOMAC categories of "pain preventing sleep" and "walks with aid". The PMI showed that the oxycodone/paracetamol therapy was adequate in patients with osteoarticular pain. In group B, 83.3% of patients reported improvement in the category of "pain preventing sleep", and all patients rated the remaining four categories ("spontaneous pain", "burning pain", "painful paresthesia", and "pinprick") as either stable or improved after 15 days of treatment. Using the PMI, hyperalgesia resolved with oxycodone/paracetamol therapy. 37.1% and 58.3% of patients did not complete the study in group A and B, respectively. The PMI was an effective tool for assessment of pain management efficacy. Oxycodone/paracetamol improved pain symptoms in the majority of compliant patients. In patients with neuropathic pain, rescue therapy with oxycodone/paracetamol showed a lesser, but significant, improvement of pain symptoms.

An evaluation of pain in haemodialysis patients using different validated measurement scales

Pain in haemodialysis is very common, although frequently underdiagnosed. Chronic pain in dialysis has been scarcely evaluated, and intradialytic pain has not been specifically analyzed. Our aim was to compare intradialytic versus chronic pain characteristics in the same group of twenty-seven hemodialyzed patients, to investigate whether there were or not differences between them. Several validated scales were used: a) Analogical Visual Scale, defines pain intensity from 0, no pain, to 10, the worst pain; b) Pain Management Index, that results from subtracting pain level from analgesic use, ranging from - 3 (inadequate) to + 3 (adequate management); c) McGill Pain Questionnaire, which defines three items: pain related qualitative index, number of words chosen, and present pain intensity; and d) Brief Pain Inventory, which analyses influence of pain in patient's life, was only aplicable to evaluate chronic pain. Tests were administered firstly during the dialysis session for evaluating intradialytic pain, and another day out of the session to evaluate chronic pain. Ischemic pain was the most common during the session (37%), whereas muscle-skeletal was more frequent out of the session (77%). Prevalence of pain was higher during the session (92.5% vs 77.7%, p < 0.05). Number of weekly sessions with pain was 1.78 +/- 1.2. Analogical visual score was slightly higher during the session with respect to chronic pain (3.28 +/- 2.22 vs 2.67 +/- 2.13, p = NS). Pain Management Index scores were significantly different (intradialytic: -0.81 +/- 0.76, chronic pain: -0.12 +/- 0.94). McGill test scores were similar in both situations. Only in chronic pain, time on dialysis correlated significantly with analogical visual scores, pain related index and number of words chosen, and parathyroid hormone levels with analogical visual scores and interference to displacement score from Brief Pain Inventory. Farmacological treatment was prescribed in 11% of patients with intradialytic pain (63.1% of responders) compared to 74% for those with chronic pain (53.1% of responders). In conclusion, pain in hemodialysis is very frequent and becomes undertreated. Pain scales used have been shown to be useful in this setting. Several differences appear between intradialytic and chronic pain. Chronic pain is less frequent and intense, better treated, mainly derived from a muscle-skeletal source, and it is related to time on dialysis and to secondary hyperparathyroidism.

Development of a pain assessment tool for the older adults in Korea: The validity and reliability of a Korean version of the geriatric pain measure (GPM-K)

The purpose of this study is to develop the GPM-K and test the validity and reliability of it. GPM-K is a multidimensional pain assessment instrument for older adults. One hundred twenty-one community-dwelling old adults aged 65 and older who expressed chronic pain were included. They completed GPM-K. The Korean version of the Brief Pain Inventory (BPI-K), Korean Mini-Mental State Examination (K-MMSE), Geriatric Depression Scale Short Form Korean version (GDSSF-K), Pain Management Index (PMI), and Elderly Life Stress Index (ELSI) were used to further validate the GPM-K. A standardized Cronbach's α was 0.92, and average inter-item correlation was 0.32. Of those, who repeated the GPM-K within 2–4 weeks (n=32), Pearson's r correlation of test–retest reliability was statistically significant (r=0.640). Correlation coefficient was highly significant between the GPM-K and mean pain severity of the BPI-K (r=0.726, p<0.001), and between the GPM-K and mean pain interference of the BPI-K (r=0.698, p<0.001), as well. The GPM-K was correlated with the GDSSF-K (r=0.256), the ELSI (r=0.312) and the PMI (r=−0.509). The GPM-K is a valid and useful instrument to assess pain and its related factors for the Korean older adults.

Postoperative Pain Management Outcome in Chinese Inpatients

In the absence of pain management outcome reports representing mainland China, the purposes of this study were to describe the outcome of postoperative pain management and the relationship between patient satisfaction and clinical outcomes in an indigenous Chinese population. From a sample of 388 second-day-postoperative inpatients, 304 (78%) reported pain in the past 24 hours and were enrolled in the study. Mean ratings for pain were moderate to severe. Patients reported mild to moderate pain-related interference with mood and physical activities. There were significant differences on worst pain intensity and pain interference with daily activity in the past 24 hours for different types of surgery. Top-ranked nonpharmacologic methods for managing pain were tolerating pain, changing positions, and family support. As measured by the Pain Management Index, 60.2% of patients were inadequately treated for pain, yet patients reported high satisfaction with pain management. Patient satisfaction, however, was inversely and significantly correlated with pain intensity. Study results indicate a need for standardized policies and guidelines about pain management and education among providers and for patients and families to overcome the suboptimal pain outcomes among this Chinese population.

Pain in elderly hospitalized cancer patients with bone metastases in Norway

To examine differences in reported pain, pain management and satisfaction with pain management between middle-aged and elderly patients. The study also examined differences in global quality of life (QoL) and pain interference with patient function between middle-aged and elderly patients with bone metastases. A one-day prevalence study was performed, targeting hospitalized cancer patients 18 years and over in Norwegian hospitals; 79 patients with bone metastases were included. In total, 89% of patients reported daily pain, and there was no significant difference between the two age groups (p=0.52). Elderly patients reported significantly higher scores for 'worst pain' (p=0.036) and 'pain severity intensity' (p=0.027), but received strong opioids for their cancer pain significantly less often than middle-aged patients (p=0.024). We found a significant linear association between increasing age and decreasing scores on Cleeland's pain management index (p=0.002). There were no statistically significant differences between age groups in satisfaction with pain management, pain interference with functioning or global QoL. These results indicate that more focus is needed on pain management in elderly cancer patients with bone metastases.

Sex Differences in the Adequacy of Pain Management Among Patients Referred to a Multidisciplinary Cancer Pain Clinic

Few studies have evaluated sex differences in the adequacy of pain management in cancer. Existing studies have been marked by methodological limitations and results have been mixed. The present study sought to determine whether sex was associated with pain severity and pain management in cancer patients newly referred by their primary oncology team to a multidisciplinary cancer pain clinic. One hundred thirty-one cancer patients completed the Brief Pain Inventory-Short Form and medical chart review was conducted to obtain patients' clinical characteristics and pain treatment data. There were no differences between males and females in ratings of worst pain in the last week. Females were significantly less likely to have been prescribed high potency opioids by their primary oncology team and significantly more likely to report inadequate pain management as measured by Pain Management Index scores. These results suggest a sex bias in the treatment of cancer pain and support the routine examination of the effect of sex in cancer pain research.