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Pain management and related factors in advanced cancer patients who initiated opioid therapy in an outpatient setting

Published online by Cambridge University Press:  13 April 2006

RIEKO KIMURA ,
SAORI HASHIGUCHI ,
MASAKO KAWA ,
MITSUNORI MIYASHITA ,
TOMOYO SASAHARA ,
YUKI SHIRAI  and
KEIKO KAZUMA
RIEKO KIMURA
Affiliation:
Keio University Hospital, Tokyo, Japan Department of Adult Nursing/Palliative Care Nursing, School of Health Sciences and Nursing, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
SAORI HASHIGUCHI
Affiliation:
Department of Anesthesiology, School of Medicine, Keio University, Tokyo, Japan
MASAKO KAWA
Affiliation:
Department of Adult Nursing/Palliative Care Nursing, School of Health Sciences and Nursing, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
MITSUNORI MIYASHITA
Affiliation:
Department of Adult Nursing/Palliative Care Nursing, School of Health Sciences and Nursing, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
TOMOYO SASAHARA
Affiliation:
Department of Adult Nursing/Palliative Care Nursing, School of Health Sciences and Nursing, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
YUKI SHIRAI
Affiliation:
Department of Adult Nursing/Palliative Care Nursing, School of Health Sciences and Nursing, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
KEIKO KAZUMA
Affiliation:
Department of Adult Nursing/Palliative Care Nursing, School of Health Sciences and Nursing, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
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Abstract

Objective: The aim of this study was to clarify the state of pain management in Japanese patients with advanced cancer who initiated opioid therapy in an outpatient setting.

Methods: Interview surveys using questionnaires were conducted and medical records were reviewed. Pain relief was defined as >33% decrease in worst pain intensity score, and significance of early pain relief was investigated in terms of changing self-efficacy for activities of daily living (ADL). Factors related to early pain relief were also investigated.

Results: The study was conducted between June and December 2003, on 20 patients (13 women, 7 men; mean age, 59 years). Compared to score at initiation of opioid administration (Numerical Rating Scale, 8.3 ± 1.3), pain relief was generally insufficient at 2 weeks (early pain relief ratio was only 42%). Patients with sufficient pain relief at 2 weeks displayed significant improvements in numerous ADL functions and symptom-coping efficacy (p = 0.037), confirming the importance of early pain relief. Early pain relief was associated with high frequency of hospital visits before opioid administration and absence of sudden excavation within the first 2 weeks.

Significance of results: Result of this study indicated insufficient pain relief at an outpatients setting with advanced cancer patients. In the meantime, patients had who their pain decrease after 2 weeks also had improved ADL and self-efficacy at the same time. These findings suggest that to achieve early pain relief in an outpatient setting, clinical staff must assess pain earlier and inform patients of possible breakthrough pain following opioid administration and available treatments for such occurrences.

Keywords

Cancer painopioidOutpatientsPain managementPain relief
Type
ORIGINAL ARTICLES
Information
Palliative & Supportive Care , Volume 3 , Issue 4 , December 2005 , pp. 301 - 309
Copyright
© 2005 Cambridge University Press

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