Pain control in cancer patients in tertiary care setting

Objective: To investigate the prevalence of significant pain and the appropriateness of analgesics treatment prescribed among cancer patients with pain in tertiary care hospitals. Material and Method: A cross-sectional study was conducted between October 2007 and June 2008 on 228 cancer patients with pain in the outpatient pain clinic of a university hospital and the inpatient ward of a regional cancer center in Bangkok Met- ropolitan Region. The Brief Pain Inventory (BPI) was used to assess pain severity and pain interference. Significant pain or inadequate pain control was defined as pain of worst intensity during 24 hours, rated by the patient as 4 or higher out of 10 on the BPI. Pain Management Index (PMI) was calcu- lated to measure the appropriateness of analgesic prescription based on the World Health Organization guidelines. Results: Only 21 patients (9.2%, 95%CI: 5.4-13.0) had negative PMI, which was indicative of inappropriate analgesic prescription. The prevalence of signifi- cant pain in the cancer patients with pain in the two tertiary care settings was 61.4% (95%CI: 55.1-67.7). Pain was reported to severely interfere with their work (34.2%), ability to walk (25.0%), and enjoyment of life (22.4%). Multivariate regression analysis revealed that inadequately treated pain was associated with being treated in the cancer center (Adjusted odds ratio 2.2, 95% confidence interval 1.2-4.1, p = 0.009). Conclusion: Despite the relaxation of opioid analgesic regulation since 2006, pain has remained under-treated in the majority of cancer pain patients even in the tertiary care services. Awareness of pain undertreatment should be raised among policy makers (such as Thai FDA) and health professionals involved. A more comprehensive and intensive approach to pain assessment and man- agement is needed. Regular assessment of the patients' compliance and preference to analgesic regimens prescribed and of pain-related cancer comorbidities (e.g., depression) should be emphasized. A policy on provi- sion of a wider variety of opioids type and preparation forms may help improve the patients' compliance and in turn reduce the pain symptoms.