Hostname: page-component-78c5997874-94fs2 Total loading time: 0 Render date: 2024-11-19T20:31:05.758Z Has data issue: false hasContentIssue false
  • English
  • Français

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
Get access Rights & Permissions [Opens in a new window]

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

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

REFERENCES

Anderson, K.O. & Cleeland, C.S. (2003). The assessment of cancer pain. In Cancer Pain Assessment and Management, Bruera, E.D. & Portenoy, R.K. (eds.), pp. 51–66. New York: Cambridge University Press.
Bennet, P. & Marie, B.S. (2002). The epidemiology of pain. In Core Curriculum for Pain Management Nursing, Marie, B.S. (ed.) pp. 45–53. Philadelphia: W.B. Saunders Company.
Bruera, E.D. & Sweeney, C. (2003). Bone pain. In Cancer Pain Assessment and Management, Bruera, E.D. & Portenoy, R.K. (eds.), pp. 413–428. New York: Cambridge University Press.
Cleeland, C.S., Gonin, R., Hatfield, A.K., et al. (1994). Pain and its treatment in outpatients with metastatic cancer. New England Journal of Medicine, 330, 592–596.Google Scholar
Farrar, J., Portenoy, R., Berlin, J., et al. (2000). Defining the clinically important difference in pain outcome measures. Pain, 88, 287–294.Google Scholar
Farrar, J., Young, J.P., Jr., LaMoreaux, L., et al. (2001). Clinical importance of changes in chronic pain intensity measured on an 11-point numerical pain rating scale. Pain, 94, 149–158.Google Scholar
Ferrell, B.R. (1995). The impact of pain on quality of life. A decade of research. Nursing Clinics of North America, 30, 609–624.Google Scholar
Hirai, K., Suzuki, Y., Tshunetou, A., et al. (2001). Self-efficacy scale for terminal cancer. Journal of Psychosomatic Medicine, 41, 19–27. (English abstract only).Google Scholar
Hirai, K., Suzuki, Y., Tsunetou, A., et al. (2002). A longitudinal study of a relationship between self-efficacy and psychological adjustment in terminal cancer. Journal of Psychosomatic Medicine, 42, 111–118. (English abstract only).Google Scholar
Kondo, Y. & Shibuya, M. (2002). Concerns about morphine and medication behavior in cancer outpatients with pain. Japanese Society of Cancer Nursing, 16, 5–16. (English abstract only).Google Scholar
Miaskowski, C. & Dibble, S.L. (1995). The problem of pain in outpatients with breast cancer. Oncology Nursing Forum, 22, 791–797.Google Scholar
Mickle, J. (2002). Cancer pain management. In Core Curriculum for Pain Management Nursing, Marie, B.S. (ed.), pp. 349–366. Philadelphia: W.B. Saunders Company.
Oliver, J.W., Kravitz, R.L., Kaplan, S.H., et al. (2001). Individualized patient education and coaching to improve pain control among cancer outpatients. Journal of Clinical Oncology, 19, 2206–2212.Google Scholar
Rhodes, D.J., Koshy, R.C., Waterfield, W.C., et al. (2001). Feasibility of quantitative pain assessment in outpatient oncology practice. Journal of Clinical Oncology, 19, 501–508.Google Scholar
Tanaka, K., Akechi, T., Okuyama, T., et al. (2002). Impact of dyspnea, pain, and fatigue on daily life activities in ambulatory patients with advanced lung cancer. Journal of Pain and Symptom Management, 23, 417–423.Google Scholar
Uki, J., Mendoza, T., Cleeland, C.S., et al. (1998). A brief cancer pain assessment tool in Japanese: The utility of the Japanese Brief Pain Inventory-BPI-J. Journal of Pain and Symptom Management, 16, 364–373.Google Scholar
Ward, S.E. & Gordon, D.B. (1996). Patient satisfaction and pain severity as outcomes in pain management: A longitudinal view of one setting's experience. Journal of Pain and Symptom Management, 11, 242–251.Google Scholar
Zech, D.F., Grond, S., Lynch, J., et al. (1995). Validation of World Health Organization Guidelines for cancer pain relief: A 10-year prospective study. Pain, 63, 65–76.Google Scholar