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.