Adequacy of cancer-related pain management and predictors of undertreatment at referral to a pain clinic
Received 15 April 2017
Accepted for publication 26 July 2017
Published 31 August 2017 Volume 2017:10 Pages 2097—2107
Checked for plagiarism Yes
Review by Single anonymous peer review
Peer reviewer comments 3
Editor who approved publication: Dr E Alfonso Romero-Sandoval
Paulo Reis-Pina,1,2 Peter G Lawlor,3–5 António Barbosa6,7
1Palliative Care Unit, Casa de Saúde da Idanha, Sintra, 2Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal; 3Ottawa Hospital Research Institute, 4Bruyère Research Institute, Bruyère Continuing Care, 5Division of Palliative Care, Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada; 6Department of Psychiatry, North Lisbon Hospital Centre, Lisbon, 7Centre of Bioethics and Palliative Care Studies Division, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
Background: Several guidelines have advocated the need for adequate cancer-related pain (CRP) management. The pain management index (PMI) has been proposed as an auditable measure of the appropriateness for analgesic therapy.
Objectives: To determine the adequacy of CRP management based on the PMI status and its patient-related predictors at the point of referral to a pain clinic (PC).
Methods: Consecutive patients referred to a PC had standardized initial assessments and status documentation on the Brief Pain Inventory (BPI) ratings; pain mechanism, using a neuropathic pain diagnostic questionnaire (the Douleur Neuropathique 4 tool); episodic pain; oral morphine equivalent daily dose; the Hospital Anxiety Depression Scale and the Emotion Thermometer scores; and cancer diagnosis, metastases, treatment, and pain duration. Predictors of “negative PMI status” [PMI(−)] were examined in logistic regression models. Variables with p<0.25 in an initial bivariable analysis were entered into a multivariable model.
Results: Of 371 participants, 95 (25.6%) had PMI(−), suggesting undertreatment of CRP. Both female sex and higher scores on the BPI’s “interference with general activity” more strongly predicted PMI(−). Patients who received either radiotherapy or one or more adjuvant analgesics prior to the initial consultation at the PC, those who had neuropathic pain, those who had a greater need for emotional help, and those with higher BPI’s “relief” scores were all less likely to be PMI(−).
Conclusion: The potential burden of patient and family distress associated with suboptimal CRP management in one in four patients should generate major public health concern and prompt appropriate educational and health policy measures to address the deficit.
Keywords: cancer pain, pain management, opioid analgesics, pain measurement
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