Background Pain experienced by patients with end-stage cancer represents a continuing source of frustration for them, their families and the healthcare team. While some patients over-report pain, the reverse is often true, so these patients could be over/under treated for pain.
Purpose To evaluate the pharmacological management of pain in cancer patients, being nursed in an internal medicine clinic without previous experience in palliative care.
Material and methods Given the increased numbers of end-stage cancer patients being admitted to this clinic, it was decided in 2014 that all pharmacological choices for pain alleviation for inpatients who remained more than one week should be systematically reviewed. A brief questionnaire was prepared to identify both patients’ satisfaction with analgesic treatment and the quality of relevant information imparted to them by the healthcare team.
Results During the first six months of 2014, 42 end-stage cancer patients participated in the study (82% of patients admitted). 26% did not need any analgesics, while an indwelling system for intravenous infusion of morphine was inserted for one patient. 45% of patients’ pain management involved some mild opioid (codeine ± paracetamol) or tramadol, 38% transdermal/transmucosal fentanyl, 26% adjuvant therapy with an antidepressant/anticonvulsant agent. Full satisfaction was reported by 68% of patients, 32% declared themselves adequately satisfied, while 60% were very pleased with the quality of information they received about their analgesic treatment.
Conclusion Since per os normal or modified release morphine formulations are not widely available in our country, tramadol (in contrast to nonsteroidal anti-inflammatory drugs) seem to be most preferred before moving to increased doses of fentanyl. In order to prevent overexposure to analgesics any pain control strategy in cancer patients should ensure that both the individual needs are being met and the ever-changing expression of pain is being captured.
References and/or acknowledgements No conflict of interest.
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