ABCD Exchange : January 1999 : Research - Practice Guidelines

Using Practice Guidelines Improves Pain Management for Cancer Patients
by Janice Lynch Schuster

Researchers followed patients for three months, taking pain measurements at five intervals: baseline; two weeks; and one, two, and three months. Pain outcomes were usual and worst pain as measured by a Brief Pain Inventory. Pain outcome tools included:

• An average pain score from a Daily Pain Diary;

• Pain character using descriptive words and a ranking scale;

• Pain interference with seven different activities;

• Pain location; and

• A composite score based on intensity, character, relief, location, and interference.

Patients whose care was facilitated by use of the pain algorithm had statistically superior results in reduction of usual pain. Control group patients had an initial decrease in pain, but finished the study with a slight increase in usual pain scores. Patients in the algorithm group, however, experienced a steady decrease in usual pain scores.

Patient did not always adhere to prescribed treatments; their failure to do so, even when pain was uncontrolled and side effects of medication were likely to be minimal, points to the need for patient education. Patients in the control and study groups complied with their prescribed opioid therapy only 62 to 72% of the time; adherence to adjuvant therapy was only slightly better. Those algorithm patients with greater adherence had significantly lower worst and usual pain scores.

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