Integration of specialized pain control services in palliative care: A nationwide web-based survey

Abstract

Introduction:Pain control is an important part of palliative care (PC), and conventional analgesics do not provide adequate pain relief to all patients. Many patients present with complex pain syndromes that require interventional pain control measures usually deployed by pain specialists. There is adequate integration of specialized pain control services with PC elsewhere, but information about the same in our country is lacking.Materials and Methods:An internet survey was conducted among palliative specialists regarding the need and availability of pain specialists for their patients suffering from complex pain syndromes. Their attitude toward integrating specialized pain control services in their practice was also explored.Results:Majority of palliative physicians came across situations where specialists in pain would control the patients’ pain better. There was a poor availability of such services, and when available, the cost was significant. It is heartening to note that though there is poor integration of specialized pain control services with palliation, palliative physicians acknowledge the need for pain specialists and their techniques for providing pain relief for their patients.Conclusions:Effective pain control is needed in palliation, barriers however exist, and there is a need to make pain specialists and interventional techniques more freely available.

Availability of and factors related to interventional procedures for refractory pain in patients with cancer: a nationwide survey

“…Factors related to the implementation of interventional procedures warrant further study. Previous studies reported the following barriers to the implementation of specialist pain management, such as neural blockade and neuraxial infusion: the underutilization of specialists [ 16 , 17 ]; access issues/geographical issues [ 18 , 19 ]; inter-facility issues [ 19 ]; inability to get appointments [ 20 ]; need for repeating procedures [ 20 ]; cost issues [ 17 , 18 , 21 ]; the short survival of patients following referral to palliative care services [ 21 ]; time on the part of the specialist for evaluation and discussion [ 16 , 21 ]; complexity [ 21 ]; continuity issues, such as the handling of pumps and catheters, creating a pump, procurement of drugs, and management at home [ 21 ]; the inexperience of palliative care physicians [ 18 ]; perception issues among palliative care physicians (interest or lack of awareness of potential benefits) [ 18 , 21 ]; and the lack of training for specialists [ 21 ]. In the present study, the number of cancer patients with pain seen annually, difficulty in gaining experience, lack of time, and lack of institutional acceptance were associated with the implementation of procedures, with the first three factors being consistent with previously reported associated factors (involvement of specialists in palliative care [ 16 ], time on the part of the specialist for evaluation and discussion [ 16 ], and the lack of training for specialists [ 21 ]).…”

“…Some non-pharmacological therapies, including neural blockade and neuraxial infusion, are effective for cancer pain, and previous studies have reported that they are used to treat 3.8-8% of cancer patients [13][14][15]. However, as there are several barriers to the implementation of these therapies [16][17][18][19][20][21], their limited availability may explain refractory cancer-related pain in some patients with cancer.…”

“…Information on the status and availability of neural blockades and neuraxial infusions for cancer pain management or the factors associated with their use are currently limited [13][14][15][16][17][18][19][20][21][22]. Previous questionnaire surveys targeted palliative care physicians, referring physicians, and representatives of facilities at which treatment was provided [16][17][18][19][20]23]; however, a national survey of the individual professionals who completed these surveys has not yet been performed.…”

Integrated approach to pain management for a patient with multiple bone metastases of uterine cervical cancer

“…All of these interventional techniques should be part of a multidisciplinary management program that constitutes the fourth consecutive step of the pain treatment ladder established by the World Health Organization. 3 …”

“…All of these interventional techniques should be part of a multidisciplinary management program that constitutes the fourth consecutive step of the pain treatment ladder established by the World Health Organization. 3 We herein report a case involving a patient with multiple bone metastases of uterine cervical cancer in which patientcentered multidisciplinary pain management provided integrated palliative care and ultimately formed a nearly painless end-of-life experience until the patient died at home. During the treatment period, some unsatisfactory curative effects and even errors occurred.…”