HOUSTON-A male cancer patient receiving opioids for pain is reluctant
to tell the female pain specialist at the clinic about his constipation
until she hands him a small computer and shows him how to use
a pen device to indicate his side effects from a list on the screen.
A hospitalized teenage cancer patient feels trapped and powerless
until the pain specialist comes by to assess his pain on a computerized
pain map (see figure). "Just give me the computer. I can
do it faster than you," he says, eager to help with his management
and feel in control again.
These are just two examples of how a handheld pen-based computer
with customized software can improve assessment of pain in the
clinic and hospital, Sonja W. Chandler, PharmD, of M.D. Anderson's
Pain and Symptom Management Service, said in her demonstration
of the new system.
However, the system, developed independently at M.D. Anderson
with input from pain specialists across the country, has the potential
to be far more than just a computerized version of the Wisconsin
Brief Pain Inventory, she said at a symposium held in conjunction
with the 8th World Congress on Pain.
The software also has the capability to record patient admissions
and discharges, medications, drug allergies, and side effects;
summarize patient information and suggest treatment plans; make
dosage conversions and compare the costs of equianalgesic opioid
dosages; and store and recall protocols for chemotherapy and emesis
Using hypertext technology, it can display the entire AHCPR clinical
practice guidelines for cancer pain management, as well as specially
prepared monographs on specific cancer pain syndromes such as
bone pain. These texts are indexed and can be searched for appropriate
treatment recommendations at the bedside.
Dr. Chandler referred to the program as a decision-support tool,
and stressed that it is not a replacement for the physician's