Patients Report Factors That Alleviate or Aggravate Pain

August 1, 2001

SEATTLE-Unrelieved cancer pain is a serious problem for over a million Americans with cancer. Many studies report factors that alleviate pain, but few report factors that aggravate it.

SEATTLE—Unrelieved cancer pain is a serious problem for over a million Americans with cancer. Many studies report factors that alleviate pain, but few report factors that aggravate it.

University of Washington researchers Marjorie Wells, PhD, ARNP; Hsiu-Ying Huang, PhD, RN, AOCN, and Diana J. Wilkie, PhD, RN, FAAN, analyzed the results of four studies in which a total of 577 cancer patients had been asked about their pain using the McGill Pain Questionnaire (MPQ).

The two relevant questions on the MPQ are: "What kind of things relieve your pain?" and "What kind of things increase your pain?" The University of Washington researchers compiled the answers, categorized and coded them, and presented results of their secondary analysis at the Oncology Nursing Society’s 26th Annual Congress in San Diego.

The researchers discovered that some people simply do not know what makes their pain feel better or worse. When asked about aggravating factors, 7.3% said "nothing or don’t know." When asked about alleviating factors, 3.6% said "nothing or don’t know."

The analysis also drew attention to the fact that the same things can be either alleviating or aggravating, even in the same person, ie, changing position can aggravate or alleviate pain; inactivity can relieve it or increase it; eating can sometimes be helpful, but swallowing acidic food or spicy food can aggravate it.

In the list of aggravating factors, only three factors—negative mood, tension, and daytime-time of day—did not also appear on the list of alleviating factors. Conversely, only three items on the alleviating factors list— spiritual, herbal medications and treatment, and distraction/pets—did not appear on the aggravating factors list.

Dr. Wells, a senior postdoctoral fellow with the Cancer Pain and Symptom Management Nursing Research Group at the University of Washington, said that further research is needed to study under what conditions the same factor can either alleviate or aggravate pain.

Implications for Complementary and Alternative Medicine

"Alleviating factors form the basis for many of our complementary and alternative medicine (CAM) practices, primarily complementary therapies, and there definitely needs to be further research of CAM practice," she said.

If there were an available, easy-to-use checklist of the most frequently cited alleviating and aggravating factors, for example, it could make pain assessment easier and more comprehensive, she said. Nurses could suggest to their patients the factors that alleviate and aggravate pain, based on reports from a variety of patients, to help them avoid unnecessary pain and learn new ways to relieve their pain.

Indeed, the literature indicates that patients are often afraid to mention that they’ve used any kind of home therapies because they were not "formally" prescribed, Dr. Wells said.

"If nurses or health care providers would ask about those factors, it would help to legitimize the patient as an expert participant in his or her care, and that is something we want to strive for," she said.

Dr. Wells also pointed out that the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) Pain Standards for 2001 (PE.1.4) require that all patients reporting pain undergo a comprehensive pain assessment, including aggravating and alleviating factors.