Ineffective Cancer Pain Management Analyzed

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

"The old message was people weren’t taking their pain medicationbecause 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 causedby most opioid analgesics were a key reason why cancer patients did not adhereto their pain medication regimen." Patients in the study told researchersthat they would rather experience pain than deal with the side effects of themedications (such as constipation and sedation).

Repeated Reassessment Required

According to an accompanying editorial by Jamie von Roenn, MD, professor ofmedicine at Northwestern University, "Lack of adequate knowledge orassessment of pain management by physicians is suggested by the pattern ofanalgesic prescriptions. Effective pain management requires repeated assessmentand adjustments in dosage."

The randomized 5-week study included 65 adult patients with baseline pain andevidence of bone metastases. Patients rated their level of pain intensity andrecorded their pain medication intake daily. Adherence rates were calculatedweekly. Overall, adherence rates ranged from 84.5% to 90.8% for around-the-clockanalgesics and 22.2% to 26.6% for as-needed analgesics. There were nosignificant changes in adherence rates, pain intensity, or duration of painduring the course of the study.

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

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