BALTIMOREBetween 65% and 85% of advanced cancer patients suffer pain,
but between 85% and 95% of those patients, if properly treated, can
experience relief. Providing effective pain management is a
multidisciplinary effort requiring detailed planning and persistent
implementation by a team committed to using a variety of resources and
techniques. These concepts and how they are integrated into the Johns
Hopkins approach to pain management were described by Suzanne A. Nesbit,
PharmD, BCPS, clinical specialist in pain management in the Department of
Pharmacy at Johns Hopkins Hospital in Baltimore and Kathy Smolinski, LCSW-C,
senior clinical social worker in the Cancer Pain Service of the Sidney
Kimmel Comprehensive Cancer Center at Johns Hopkins.
Central to the Hopkins approach is the belief that "communication is
the key" to properly assessing and controlling pain, Ms. Smolinski said
at an industry-sponsored symposium held in conjunction with the Oncology
Nursing Society annual meeting. As a first step toward pain control, each
cancer patient seen at Hopkins completes a common problem checklist. The
answers help members of the Cancer Pain Service combine assessing a patient’s
level of pain with educating him or her about pain control, Dr. Nesbit said.
Pain Rated Daily
The program includes a pain rating done for each patient daily, she
continued. Anyone reporting a pain level of four or higher is evaluated by
the pain service, which is committed to "return [to the patient’s
case] relentlessly until the pain is managed," Dr. Nesbit said. Special
rounds and weekly case conferences also concentrate on controlling each
patient’s pain. To help streamline the pain control team’s work, the
special data base being developed can be accessed by a palm-held computer.
Patients overwhelmingly report that their nurses are the best source for
education about pain management, Ms. Smolinski added. Because patients often
feel unsure what or how to ask, nurses at Hopkins use handouts, including a
question and answer sheet intended both to answer patients’ unspoken
questions and to encourage discussion. At discharge, each patient also
receives specific pain management instructions, she noted.