New Clinical-Practice Guidelines for the Management of Pain in Patients with Cancer

Jacox, Ada; Carr, Daniel B.; Payne, Richard

doi:10.1056/nejm199403033300926

Cited by 297 publications

(148 citation statements)

References 10 publications

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“…This is disappointing because, with a correct use of WHO analgesic ladder, up to 88% of patients is reported to obtain satisfactory relief from pain (Ventafridda et al, 1987;Zech et al, 1995). It is recommended that treatment should start at the step of the analgesic ladder appropriate for the severity of pain, and all patients with moderate-to-severe cancer pain, regardless of aetiology, should receive a trial of opioid analgesia (Jacox et al, 1994). However, very frequently this does not happen.…”

mentioning

confidence: 99%

Prevalence and management of pain in Italian patients with advanced non-small-cell lung cancer

Maïo¹,

Gridelli²,

Gallo³

et al. 2004

Br J Cancer

116

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Pain is a highly distressing symptom for patients with advanced cancer. WHO analgesic ladder is widely accepted as a guideline for its treatment. Our aim was to describe pain prevalence among patients diagnosed with advanced non-small-cell lung cancer (NSCLC), impact of pain on quality of life (QoL) and adequacy of pain management. Data of 1021 Italian patients enrolled in three randomised trials of chemotherapy for NSCLC were pooled. QoL was assessed by EORTC QLQ-C30 and LC-13. Analgesic consumption during the 3 weeks following QoL assessment was recorded. Adequacy of pain management was evaluated by the Pain Management Index (PMI). Some pain was reported by 74% of patients (42% mild, 24% moderate and 7% severe); 50% stated pain was affecting daily activities (30% a little, 16% quite a bit, 3% very much). Bone metastases strongly affected presence of pain. Mean global QoL linearly decreased from 64.9 to 36.4 from patients without pain to those with severe pain (Po0.001). According to PMI, 616 out of 752 patients reporting pain (82%) received inadequate analgesic treatment. Bone metastases were associated with improved adequacy and worst pain with reduced adequacy at multivariate analysis. In conclusion, pain is common in patients with advanced NSCLC, significantly affects QoL, and is frequently undertreated. We recommend that: (i) pain self-assessment should be part of oncological clinical practice; (ii) pain control should be a primary goal in clinical practice and in clinical trials; (iii) physicians should receive more training in pain management; (iv) analgesic treatment deserves greater attention in protocols of anticancer treatment.

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mentioning

confidence: 99%

Prevalence and management of pain in Italian patients with advanced non-small-cell lung cancer

Maïo¹,

Gridelli²,

Gallo³

et al. 2004

Br J Cancer

116

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“…Algunos autores refieren que este tipo de estímulos puede aumentar el crecimiento tumoral y la diseminación metastásica; otros investigadores refieren que hay disminución del dolor sin eventos adversos; en las guías de práctica clínica AHCPR (Agency for Health Care Policy and Research) 44 para el manejo del dolor oncológico concluyeron que ante la ausencia de evidencia que contraindique claramente el uso de esta técni-ca, el calor superficial puede ser utilizado como método de control del dolor en pacientes oncológicos, teniendo precaución en los pacientes con deterioro cognitivo o con alteración de la sensibilidad. Adicionalmente se recomienda que técnicas de calor profundo (como ultrasonido, microondas) se utilicen con precaución en pacientes con cáncer activo, no aplicar directamente en sitios de cáncer o metástasis, o en zonas en donde se ha realizado radioterapia recientemente.…”

Section: Medidas No Farmacológicasunclassified

Rehabilitación del paciente con enfermedad ósea metastásica: Un desafío

Capacho¹,

Mojica

2016

Rev Col Med Fis Reh

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95Rehabilitación del paciente con enfermedad ósea metastásica: Un desafío Rev Col Med Fis Rehab 2016; 26(1): 95-108 ARTÍCULO DE REVISIÓN RESUMENLa enfermedad ósea metastásica es una condición que frecuentemente impacta de forma negativa la funcionalidad y calidad de vida de los pacientes con cáncer, por lo cual esta condición se convierte en un desafío para el grupo oncológico tratante y de soporte; en especial para los especialistas en rehabilitación, quienes deben buscar un equilibrio entre los riesgos de aparición de eventos adversos a causa de sus intervenciones y la preservación de la funcionalidad. El objetivo de esta revisión es dar a conocer las principales pautas sobre el diagnóstico clínico, el diagnóstico imagenológico, los fundamentos del tratamiento quirúrgico y las opciones en rehabilitación, para que el especialista pueda tomar las mejores decisiones de tratamiento y establecer objetivos de rehabilitación eficientes en los pacientes con enfermedad ósea metastásica.Palabras clave: metástasis de las neoplasias, hueso, rehabilitación. ABSTRACTThe bone metastases is a condition that often impresses of negative form the functionality and quality of life of the patients with cancer, for which dealer turns this condition into a challenge for the oncological group and of support; especially for the specialists in rehabilitation, who must look for a balance between the risks of appearance of adverse events because of its interventions and the preservation of the functionality. The object of this review is to announce the main rules on the clinical diagnosis, the imaging diagnosis, the essentials of the surgical treatment and the options in rehabilitation, so that the specialist could take the best decisions of treatment and establish efficient rehabilitation targets in the patients with bone metastases.

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“…8 Cancer pain is multidimensional and includes psychosocial and spiritual components, 36 and multidisciplinary pain management is widely accepted as a standard of care. 4,37 Physicians certainly play key roles in pain management, especially in the prescription of opioids. However, nurses also play key roles in pain management, because they are involved in pain assessment, patient education about pain medication, nonpharmacologic management, and management of medication side effects.…”

Section: Original Articlementioning

confidence: 99%

Variations in pain management outcomes among palliative care centers and the impact of organizational factors

Shin

Hwang

et al. 2012

Cancer

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BACKGROUND:The assessment of pain management outcomes is important for the quality assurance of palliative care. The objective of this study was to determine whether there are significant variations in pain management outcomes among palliative care centers and whether they are affected by organizational factors. METHODS: Data used in this investigation were from the 2009 Korean Terminal Cancer Patient Information System and administrative records of the 34 inpatient palliative care centers designated by the Korean Ministry of Health and Welfare in 2009. Self-reported pain scores (range, from 0 to 10) at admission and 1 week after admission were prospectively collected. Multilevel mixed-effect regression models were used to analyze the variations and the impact of organizational-level factors on 2 pain management outcomes (ie, reduction in average pain score and achievement of adequate pain control at 1 week after admission). RESULTS: In total, 1711 patients with terminal cancer were included in the analyses. The mean reduction in the pain score was 0.69 to 1.91 after 1 week, and most patients (82.8%) achieved adequate pain control. There were significant variations in pain management outcomes among palliative care centers. Higher composite scores for human resources adequacy were associated significantly with a greater reduction in pain score (b, 0.11; 95% confidence interval, 0.01-0.21), and achievement of adequate pain control (adjusted odds ratio, 1.26; 95% confidence interval, 1.10-1.45). CONCLUSIONS: There were significant variations in pain management outcomes among inpatient palliative care centers, and they were affected by organizational factors, such as human resources adequacy. Cancer 2012;118:5688-97.

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New Clinical-Practice Guidelines for the Management of Pain in Patients with Cancer

Cited by 297 publications

References 10 publications

Prevalence and management of pain in Italian patients with advanced non-small-cell lung cancer

Prevalence and management of pain in Italian patients with advanced non-small-cell lung cancer

Rehabilitación del paciente con enfermedad ósea metastásica: Un desafío

Variations in pain management outcomes among palliative care centers and the impact of organizational factors

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