Background The ultimate objective of cancer pain management is the elimination or reduction to bearable levels. Evaluating pain should use validated instruments. Our institution’s strategy involves asking patients to self-report pain intensity using a 10-level Numerical Rating Scale (NRS) (mild (1–3) moderate (4–6), severe (7–10)) correlating with the WHO pain ladder and recommended dosing guidelines.1
Purpose To determine how pain was evaluated, its intensity and prevalence, and whether guidelines were applied. This will be a starting point for comparisons when implementing and evaluating future strategies to improve oncological pain management.
Material and methods Retrospective study of data from all patients hospitalised in our university hospital oncology unit from 15 March to 15 June 2017 who gave informed consent. Data retrieved from patients’ medical records included means of pain intensity evaluation, intensity, prescribed analgesic doses and administration routes.
Results One hundred and sixteen patients were included, representing 153 hospitalisations and 1701 evaluations, of which 940 were positive for pain. 693 evaluations used non-validated qualitative-scale criteria; 356 evaluations used the NRS; and 109 were mixed evaluations. NRS-evaluated pain levels and analgesics for treatment were: mild pain=37% (WHO ladder 1=38%, ladder 2=3%, ladder 3=55%, other adjuvant=4%); moderate pain=44%, (WHO ladder 1=30%, ladder 2=4%, ladder 3=58%); and severe pain=19% (WHO ladder 1=34%, ladder 2=4%, ladder 3=52%, other adjuvant=9%). Concerning good dosing practices, independently of pain level, the most used WHO ladder 3 analgesic was morphine (52% parenteral (38% subcutaneous, 14% intravenous), 48% PO (33% sirup)), involving single 4-hourly morphine doses: subcutaneous (2–8 mg) of which 59%<5 mg; intravenous (2–6 mg) of which 24%<5 mg; sirup (1–15 mg): of which 89%<10 mg.
Conclusion Because most pain intensity evaluations are made without using a validated ladder, drawing conclusions about whether good dosing-practice guidelines are being followed is impossible, and reliable prevelance rates cannot be calculated. We must understand whether pain assessment is inadequately done or whether the problem involves documentation. Considering our NRS results, it seems that both the presence of pain and its intensity remain highly problematic within our unit. Another concern is why prescribers favour seemingly weak subcutaneous morphine doses. Oral morphine doses also seem affected by under-dosage. Further research is needed.
Reference and/or Acknowledgements 1. Ripamonti C. Annals of Oncology2012:23(7).
No conflict of interest
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