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. 2017 Aug 31:10:2097-2107.
doi: 10.2147/JPR.S139715. eCollection 2017.

Adequacy of cancer-related pain management and predictors of undertreatment at referral to a pain clinic

Paulo Reis-Pina  1   2 , Peter G Lawlor  3   4   5 , António Barbosa  6   7
Affiliations

Adequacy of cancer-related pain management and predictors of undertreatment at referral to a pain clinic

Paulo Reis-Pina et al. J Pain Res. .

Abstract

Background: Several guidelines have advocated the need for adequate cancer-related pain (CRP) management. The pain management index (PMI) has been proposed as an auditable measure of the appropriateness for analgesic therapy.

Objectives: To determine the adequacy of CRP management based on the PMI status and its patient-related predictors at the point of referral to a pain clinic (PC).

Methods: Consecutive patients referred to a PC had standardized initial assessments and status documentation on the Brief Pain Inventory (BPI) ratings; pain mechanism, using a neuropathic pain diagnostic questionnaire (the Douleur Neuropathique 4 tool); episodic pain; oral morphine equivalent daily dose; the Hospital Anxiety Depression Scale and the Emotion Thermometer scores; and cancer diagnosis, metastases, treatment, and pain duration. Predictors of "negative PMI status" [PMI(-)] were examined in logistic regression models. Variables with p<0.25 in an initial bivariable analysis were entered into a multivariable model.

Results: Of 371 participants, 95 (25.6%) had PMI(-), suggesting undertreatment of CRP. Both female sex and higher scores on the BPI's "interference with general activity" more strongly predicted PMI(-). Patients who received either radiotherapy or one or more adjuvant analgesics prior to the initial consultation at the PC, those who had neuropathic pain, those who had a greater need for emotional help, and those with higher BPI's "relief " scores were all less likely to be PMI(-).

Conclusion: The potential burden of patient and family distress associated with suboptimal CRP management in one in four patients should generate major public health concern and prompt appropriate educational and health policy measures to address the deficit.

Keywords: cancer pain; opioid analgesics; pain management; pain measurement.

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Conflict of interest statement

Disclosure At the time the study was carried out, Dr Reis-Pina was a member of the clinical staff at the PC of the Portuguese Cancer Institute (Lisbon, Portugal). In the past 5 years, Dr Reis-Pina has received honoraria from Laboratórios Vitória, S.A. Portugal; Grünenthal, S.A. Portugal; and Angelini Farmacêutica, Lda. The other authors report no conflicts of interest in this work.

Figures

Figure 1
Figure 1
Derivation of study sample and PMI status. Abbreviation: PMI, pain management index.
See this image and copyright information in PMC

References

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