HOLLYWOOD, Florida The first review of the pain assessment database
established by the National Comprehensive Cancer Network (NCCN) has shown that
pain is documented in the vast majority of cases.
"Pain is being screened in some way nearly all the time," Sharon
M. Weinstein, MD, said at the NCCN’s Seventh Annual Conference. "In the
majority of patients, over 60%, pain was documented in between 75% and 100% of
encounters." Dr. Weinstein is director of pain medicine and palliative
care, Huntsman Cancer Institute, University of Utah.
The results are based on 116 records (more than 1,000 documentation
episodes) collected continuously for 3 months at five NCCN institutions. The
study will be complete at 250 cases. Patients studied were those with breast
cancer and metastatic bone disease.
With no uniform pain documentation protocol in place at the institutions,
the investigators looked for verbal mentions of pain or pain intensity scores. About 60% of the pain mentions used the numeric
rating (0 to 10). Nurses, according to the review, used the numeric system
significantly more often than physicians when documenting pain.
Nurses were the mostly likely to document pain (nearly 50%), followed by
nursing assistants (15%). Oncology fellows, members of the pain team,
consultant MDs, and others each documented pain less than 5% of the time.
Documenting Pain Characteristics
The researchers also looked for documentation of certain pain
characteristics: location, etiology, pathophysiology, or all three. About 70%
of the pain mentions included location. Etiology was recorded in about 20% of
the pain mentions, and pathophysiology in about 25%. All three characteristics
were recorded in less than 20% of the pain mentions.