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.