DOI: http://dx.doi.org/10.18203/2319-2003.ijbcp20170316

Adequacy of pain management in oncology patients at a tertiary hospital in Ghana

Akua A. Abruquah, Robert P. Biney, Ernest B. Osei-Bonsu, Kofi M. Boamah, Eric Woode

Abstract


Background: Although cancer pain is well documented, efficient management is largely inadequate in most patients especially in developing countries. This study evaluated the adequacy of pain management as well as potential social factors that may be associated with inadequate pain management.

Methods: 204 ambulatory oncology patients (82% female; mean age 53.5) attending clinic at the Oncology Directorate, of a tertiary hospital in Ghana from January to December, 2015 were recruited and their pain severity and functional interference assessed with the Brief Pain Inventory (BPI). The adequacy of pain management was computed as the pain management index (PMI) using the BPI.

Results: Although 62% of respondents were prescribed high potency opioids, 56.9% of them exhibited significant pain while 34.9% required a stronger analgesic to manage their pain. Majority of patients (56%) were over-managed for their pain (had PMI score >0). Only 26.4% had optimal cancer pain management. Pain interfered mostly with patients’ sleep (46.2%) and general activity (42.5%). Patients with high pain intensity were more likely to have it affect their daily activity (P<0.0001). Men were more likely to have inadequate pain management than females.

Conclusions: This study has shown that whereas pain management may be adequate, there is the tendency for opioid tolerance and abuse as over 50% of patients receive more analgesics than required. The tenets of the WHO 3-step analgesic ladder should be strictly adhered to achieve optimum cancer pain relief.


Keywords


Analgesics, Brief pain inventory, Cancer pain, Pain management index

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References


Reyes-Gibby CC, Ba Duc N, Phi Yen N, Hoai Nga N, Van Tran T, Guo H et al. Status of cancer pain in Hanoi, Vietnam: A hospital-wide survey in a tertiary cancer treatment center. J Pain Symptom Manage. 2006;31(5):431-9.

Okuyama T, Wan, XS, Akechi T, Mendoza TR, Hosaka T, Cleeland CS et al. Adequacy of cancer pain management in a Japanese Cancer Hospital. Jpn J Clin Oncol. 2004;34(1):37-42.

Batalha LM, Mota AA. Massage in children with cancer: effectiveness of a protocol. J Pediatr (Rio J). 2013;89(6):595-600.

Black B, Herr K, Fine P, Sanders S, Tang X, Bergen-Jackson K et al. The relationships among pain, nonpain symptoms, and quality of life measures in older adults with cancer receiving hospice care. Pain Med. 2011;12(6):880-9.

Ballout S, Noureddine S, Huijer HA, Kanazi G. Psychometric evaluation of the arabic brief pain inventory in a sample of Lebanese cancer patients. J Pain Symptom Manage. 2011;42(1):147-54.

Aisyaturridha A, Naing L, Nizar AJ. Validation of the Malay Brief Pain Inventory questionnaire to measure cancer pain. J Pain Symptom Manage. 2006;31(1):13-21.

Prommer EE. Pharmacological Management of Cancer-Related Pain. Cancer Control. 2015;22(4):412-25.

Wiredu EK, Armah HB. Cancer mortality patterns in Ghana: a 10-year review of autopsies and hospital mortality. BMC public health. 2006;6(1):1.

Larue F, Fontaine A, Colleau SM. Underestimation and undertreatment of pain in HIV disease: multicentre study. Bmj. 1997;314(7073):23.

Caffo O, Sava T, Comploj E, Fariello A, Zustovich F, Segati R et al. Impact of docetaxel-based chemotherapy on quality of life of patients with castration-resistant prostate cancer: results from a prospective phase II randomized trial. BJU Int. 2011;108(11):1825-32.

Eggermont LH, Leveille SG, Shi L, Kiely DK, Shmerling RH, Jones RN et al. Pain characteristics associated with the onset of disability in older adults: the maintenance of balance, independent living, intellect, and zest in the Elderly Boston Study. J Am Geriatr Soc. 2014;62(6):1007-16.

Bortsov AV, Platts-Mills TF, Peak DA, Jones JS, Swor RA, Domeier RM et al. Effect of pain location and duration on life function in the year after motor vehicle collision. Pain. 2014;155(9):1836-45.

Mitera G, Fairchild A, DeAngelis C, Emmenegger U, Zurawel-Balaura, L, Zhang, L et al. A multicenter assessment of the adequacy of cancer pain treatment using the pain management index. J Palliat Med. 2010;13(5):589-93.

Atkinson TM, Mendoza TR, Sit L, Passik S, Scher HI, Cleeland C et al. The Brief Pain Inventory and its pain at its worst in the last 24 hours item: clinical trial endpoint considerations. Pain Med. 2010;11(3):337-46.

McKee MD, Kligler B, Fletcher J, Biryukov F, Casalaina W, Anderson B et al. Outcomes of acupuncture for chronic pain in urban primary care. J Am Board Fam Med. 2013;26(6):692-700.

Jacox A, Carr DB, Payne R. New clinical-practice guidelines for the management of pain in patients with cancer. N Engl J Med. 1994;330(9):651-5.

Benedetti S, Pirola B, Pollo B, Magrassi L, Bruzzone MG, Rigamonti D et al. Gene therapy of experimental brain tumors using neural progenitor cells. Nat Med. 2000;6(4):447-50.

Ogboli-Nwasor E, Makama J, Yusufu L. Evaluation of knowledge of cancer pain management among medical practitioners in a low-resource setting. J Pain Res. 2013;6:71-7.

Donovan KA, Taliaferro LA, Brock CW, Bazargan S. Sex differences in the adequacy of pain management among patients referred to a multidisciplinary cancer pain clinic. J Pain Symptom Manage. 2008;36(2):167-72.

Organizations JCoAoH. Joint Commission on Accreditation of Healthcare Organizations pain standards for 2001. Joint Commission Resources, Inc.

Edrington JM, Paul S, Dodd M, West C, Facione N, Tripathy D et al. No evidence for sex differences in the severity and treatment of cancer pain. J Pain Symptom Manage. 2004;28(3):225-32.

Beauregard L, Pomp A, Choiniere M. Severity and impact of pain after day-surgery. Can J Anaesth. 1998;45(4):304-11.