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Ineffective Cancer Pain Management Analyzed

Ineffective Cancer Pain Management Analyzed

A new study found that lack of adherence to pain medication regimens and inadequate analgesic prescriptions are the main reasons cancer patients do not achieve adequate pain relief. The study observed cancer patients in their homes in order to determine whether they were adhering to the pain management regimens prescribed by their doctors. Researchers from the Schools of Nursing, Medicine, and Pharmacy at the University of California in San Francisco (UCSF) conducted the study, which was reported in the Journal of Clinical Oncology (19:4275-4279, 2001).

"The old message was people weren’t taking their pain medication because of fear of addiction," said Christine Miaskowski, RN, PhD, professor and chair of the department of physiological nursing at UCSF. "Our study debunks that explanation, and found that the side effects caused by most opioid analgesics were a key reason why cancer patients did not adhere to their pain medication regimen." Patients in the study told researchers that they would rather experience pain than deal with the side effects of the medications (such as constipation and sedation).

Repeated Reassessment Required

According to an accompanying editorial by Jamie von Roenn, MD, professor of medicine at Northwestern University, "Lack of adequate knowledge or assessment of pain management by physicians is suggested by the pattern of analgesic prescriptions. Effective pain management requires repeated assessment and adjustments in dosage."

The randomized 5-week study included 65 adult patients with baseline pain and evidence of bone metastases. Patients rated their level of pain intensity and recorded their pain medication intake daily. Adherence rates were calculated weekly. Overall, adherence rates ranged from 84.5% to 90.8% for around-the-clock analgesics and 22.2% to 26.6% for as-needed analgesics. There were no significant changes in adherence rates, pain intensity, or duration of pain during the course of the study.

Federal guidelines recommend that all cancer patients with chronic pain be prescribed an around-the-clock analgesic regimen, as well as a short-acting supplement for breakthrough pain. However, not all patients received both types of medication. In the study, 13.9% of patients were prescribed opioid analgesics on an around-the-clock basis, 56.9% were prescribed opioid analgesics on an as-needed basis, and 29.2% were prescribed both around-the-clock and as-needed analgesics. "Poor adherence may, therefore, in part reflect the lack of relief from inadequate analgesic prescriptions," said Dr. von Roenn.

Dr. Miaskowski also stressed the need for patients to talk to their physicians about the management of side effects.

 
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