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Query: UMLS:C0596240 (cancer pain)
 3,066 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The knowledge and attitudes toward cancer pain management of physicians, nurses, and pharmacists in the state of New Hampshire were examined through the use of a statewide survey. Many of the providers who completed the survey, and thus indicated that they treated patients with cancer pain on a regular basis, were not pain or oncology specialists. Most of these providers were quite well informed about the fundamentals of cancer pain management. Approximately 90% of providers in all three groups were not concerned about addiction among cancer patients. Yet, there was a small percentage of providers who responded in less than optimal ways to items dealing with opioid pharmacology, pain assessment, and the importance of pain relief. Comparison of responses among provider groups indicated that nurses were the most knowledgeable and pharmacists the least knowledgeable about pain assessment. Physicians were the most knowledgeable regarding opioid pharmacology but seemed the least committed to providing optimal pain relief. Further analysis identified a small group of physicians that included a disproportionately high percentage of family practitioners and surgeons who consistently responded in less than optimal ways to items dealing with the importance of pain relief. The results of this study indicate a continuing need for broad-based educational programs in cancer pain management and for new initiatives focused on practitioners who see relatively few cancer patients and may have difficulty accessing traditional educational programs.
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PMID:Knowledge and attitudes of health-care providers toward cancer pain management: a comparison of physicians, nurses, and pharmacists in the state of New Hampshire. 967 Jun 34

Inadequate training of physicians contributes to the undertreatment of cancer pain. To address these concerns, the University of Kentucky has introduced a 4-week course for final-year medical students that teaches the principles of clinical pharmacology and pain management. The purposes of this study are to assess the knowledge deficits of final-year medical students about the use of morphine for cancer pain and to assess the efficacy of a short course on cancer pain management. Eighty-six final-year medical students completed a 22-item questionnaire assessing their knowledge and attitudes toward the use of morphine for cancer pain. Students indicated their agreement with each statement on a four-point scale (one, strongly disagree; four, strongly agree). All students then completed a compulsory short course on pain management. The course content included a 1-hr lecture on chronic nonmalignant pain, a 1-hr lecture on acute pain management, and a 1-hr lecture on cancer pain management. In addition, students completed small-group, problem-based learning modules on several aspects of pain management. After the course, all students completed the same 22-item survey. The alpha reliability score of the pretest instrument was 0.55, and the posttest reliability was 0.86. Upon course completion, students agreed most strongly (mean +/- SEM) that morphine should be given on a regular schedule for cancer pain (3.41 +/- 0.08), that cancer pain management frequently requires co-analgesics (3.36 +/- 0.06), and that patients with good pain relief function better than those with continuing pain (3.39 +/- 0.08). A comparison of pretest and posttest means on specific items suggested that the greatest amount of learning took place in the following content areas: morphine is a good oral analgesic; increases in cancer pain should be treated by increasing the morphine dose; respiratory depression is not a concern for cancer pain patients; and morphine can be used over a wide range of doses. The regular use of morphine was recognized as the treatment drug of choice for cancer pain. The students showed improved knowledge scores on ten of the 22 items on the posttest survey. A significant increase in learning occurred on six knowledge and attitude items. On only one item (nausea as a side effect of morphine) did the knowledge scores decrease on the posttest. A significant minority (40%) of senior medical students had deficits in knowledge about the use of morphine for cancer pain. The risk of addiction, respiratory depression, and tolerance were misunderstood by a significant minority (25%) of students.
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PMID:Medical student knowledge of morphine for the management of cancer pain. 967 Jun 36

The purposes of this study were to (a) test the feasibility of the Cancer Total Quality Pain Management (TQPM) Patient Assessment Tool in a population of oncology inpatient and outpatients; and (b) identify factors associated with poor pain relief. The Cancer TQPM Tool was adapted from the American Pain Society's Quality Assurance Standards on Acute Pain and Cancer Pain and was tested in a convenience sample of 200 patients. The majority of patients reported that the TQPM Tool was easy to understand and to use, providing evidence for the feasibility of the tool. Factors associated with higher pain intensity included the inpatient setting, the presence of metastatic disease, hesitancy in bothering the nurse, and concerns regarding tolerance and addiction. Although there was a strong relationship between concern about addiction and concern about tolerance, fear of tolerance appeared to have a greater effect on pain intensity scores than did fear of addiction. The findings from this study suggest that the Cancer TQPM Patient Assessment Tool can be used effectively in both inpatients and outpatients to determine outcomes and the quality of cancer pain management, as well identify factors associated with poor pain control. Clinical implications include more effective education of patients and caregivers, including equivalent emphasis on tolerance and addiction.
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PMID:Barriers to cancer pain relief: fear of tolerance and addiction. 970 52

To assess the attitudes of health care professionals in West Virginia about cancer pain, we utilized an 11-item questionnaire developed by DeWiessman and T.L. Dahl. We administered this questionnaire to 727 health care professionals and chi-square tests were used to assess correlations between attitudes on cancer pain and demographic characteristics (e.g. age, family history of cancer, sex, etc.). The majority of respondents believed that greater than 60% of cancer patients experience pain and that most patients were undermedicated with respect to pain. Age and having a family member with cancer were the major factors affecting attitudes. Respondents less than 46 years old compared to those 46 or older, were more likely to believe that most cancer patients were undermedicated; that addiction to narcotics is rare; and that the patient is the best judge of cancer pain intensity. Respondents with a family member with cancer were less likely to be concerned about addiction if a family member is given morphine. We conclude that educational efforts should be directed at altering attitudes regarding cancer pain in individuals age 46 years or older and those without a family history of cancer.
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PMID:Attitudes about cancer pain: a survey of 727 health care professionals in West Virginia. 973 83

The effectiveness of cancer pain therapy is influenced by the attitudes and knowledge of the treating physicians. As part of a quality improvement project in the management of cancer pain, a survey of 236 medical practitioners was conducted. One hundred seventy-six respondents (74.5%) completed the survey. Fifty-two percent treated patients with cancer pain several times a week or more. Whereas 57.7% of physicians stated that 76-100% of patients could achieve a satisfactory outcome from analgesic therapy, only 17.2% of respondents reported that > 75% actually achieve a satisfactory outcome in their own experience. Unsatisfactory outcome was ascribed to inadequate pain relief (59.7%), or excessive central nervous system (CNS) side effects (43.3%). According to the responding physicians, the major barriers to effective relief include inadequate assessment of the pain and pain relief (65.3%), inadequate knowledge of pain therapy (57.9%), and physician reluctance to prescribe opioids (49.1%). Questions evaluating physician knowledge identified widely prevalent knowledge deficits in pain physiology, risk of addiction, use of adjuvant analgesics, opioid dosing, and treatment of side effects. Specialists in oncology tended to evaluate their knowledge more highly than others (P < 0.05). Despite this, there was no significant knowledge difference between oncologists and noncancer specialists. The data highlight some of the barriers to the successful management of cancer pain in Israel, the prevalence of knowledge deficits, and the common disparity between clinicians' self-assessment of clinical competence and their ability to respond correctly to questions on the management of cancer pain.
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PMID:Cancer pain: knowledge and attitudes of physicians in Israel. 1020 79

Patients with cancer have diverse symptoms, impairments in physical and psychological functioning, and other difficulties that can undermine their quality of life. If inadequately controlled, pain can have a profoundly adverse impact on the patient and his or her family. The critical importance of pain management as part of routine cancer care has been forcefully advanced by WHO, international and national professional organisations, and governmental agencies. The prevalence of chronic pain is about 30-50% among patients with cancer who are undergoing active treatment for a solid tumour and 70-90% among those with advanced disease. Prospective surveys indicate that as many as 90% of patients could attain adequate relief with simple drug therapies, but this success rate is not achieved in routine practice. Inadequate management of pain is the result of various issues that include: undertreatment by clinicians with insufficient knowledge of pain assessment and therapy; inappropriate concerns about opioid side-effects and addiction; a tendency to give lower priority to symptom control than to disease management; patients under-reporting of pain and non-compliance with therapy; and impediments to optimum analgesic therapy in the healthcare system. To improve the management of cancer pain, every practitioner involved in the care of these patients must ensure that his or her medical information is current and that patients receive appropriate education.
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PMID:Management of cancer pain. 1033 6

The therapeutic opioid methadone, used to treat cancer pain and opioid addiction, is also a potent inducer of apoptosis in human lung cancer cells, thereby inhibiting their growth. However, in contrast to its central nervous system (CNS) actions, this effect appears to be mediated through a non-opioid mechanism involving bombesin, an autocrine growth-stimulatory factor that plays a central role in the early events of pulmonary carcinogenesis. Exposure of 'variant' small cell lung carcinoma (SCLC) and non-SCLC cells, which secrete low concentrations (< 0.01 pmol/mg protein) of bombesin, to nanomolar concentrations of methadone resulted in increased levels of mitogen-activated protein (MAP) kinase phosphatases and inactivation of MAP kinase, suppression of the bcl-2 protein, and induction of apoptosis. These effects of methadone were reversed by the addition of bombesin to the culture medium, at concentrations of < 1 microM, and 'classic' SCLC cells, which secrete high concentrations of bioactive bombesin (> 6 pmol/mg protein), were found not to respond to methadone. Thus, methadone's effectiveness is dependent upon the concentration of bioactive bombesin secreted by lung cancer cells. Methadone treatment suggests a novel therapeutic approach for patients presenting 'variant' SCLC and non-SCLC morphologies, since they respond less to conventional therapy.
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PMID:Effects of bombesin on methadone-induced apoptosis of human lung cancer cells. 1035 47

This study set out to clarify the situation with regard to pain control among cancer patients and the links between this and their sense of well-being in their daily lives. The study was carried out by means of a questionnaire distributed to 49 patients with cancer pain admitted to a general hospital. The survey showed that about 15% of the subjects were somewhat or very dissatisfied with the pain control. It also revealed that pain intensity correlated significantly with dissatisfaction with regard to pain control as well as with anger resulting from a feeling that there was no point in reporting the pain because the doctors and nurses did nothing. Over half the subjects assumed that an increase in pain signified progression of the disease. With regard to the use of pain medication, over half the subjects were worried about resulting tolerance of or addiction to analgesics, and the strength of their concerns showed a significant negative correlation with the score assigned to their sense of well-being. The intensity of pain also correlated significantly with a tendency to become easily fatigued, a lowering of vitality and physical strength, and an increase in psychological and emotional distress.
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PMID:[A study of well-being and pain control in cancer patients]. 1042 76

Pain is often the most prevalent symptom among cancer patients referred to hospice or palliative care programs. This study was designed to use performance-based testing to evaluate the skills of hospice nurses in assessing the severe pain of a cancer patient and the pain management recommendations they would present to the patient's primary care physician. Twenty-seven hospice nurses (ranging in experience from 1 month to 10 years) were presented with the same standardized patient with cancer pain. In Part A (7 minutes), one of the investigators checked for predetermined behaviors as the nurses performed the clinical pain assessment. In Part B (7 minutes), the nurses answered questions regarding their recommendations for pain management for the patient seen in Part A. In the admission pain assessment, hospice nurses did well in assessing pain intensity (85%), pain location (70%), and pain-relieving factors (59%). However, only 48% of the nurses adequately assessed the pain onset, and only 44% adequately assessed other symptoms the patient might be experiencing. In Part B, 96% of the nurses recommended opioids, 96% recommended the oral route of administration, and 82% recommended regular dosing of the opioids. Fifty-six percent of nurses included a breakthrough medication in their analgesic recommendations. All of the hospice nurses treated the patient's fear of addiction in an appropriate manner, and 93% of the nurses recommended increasing the patient's opioid dosage to treat the persisting pain problem. There were no significant differences among nurses with regard to length of time as a hospice nurse or hospice certification on any of the items in either Part A or Part B. Most practicing hospice nurses were judged to be competent in the assessment and management of the severe pain of the standardized cancer patient, although some deficits were noted. Regular oral opioids were the analgesics of choice. Co-analgesics were rarely recommended.
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PMID:Cancer pain assessment and management recommendations by hospice nurses. University of Kentucky, Lexington, Kentucky. 1048 57

A growing body of literature has demonstrated the widespread undertreatment of pain in patients with AIDS. While clinician-related barriers to cancer pain management have been studied, to date there has been no systematic attempt to survey clinician-related barriers to the management of pain in patients with AIDS. We surveyed AIDS health care providers' attitudes towards pain management, as well as their perception of the barriers to adequate pain management in patients with HIV disease. Subjects were 492 AIDS care providers attending continuing education symposia on the clinical management of pain in patients with AIDS in 5 major U.S. cities (New York, Philadelphia, San Francisco, Los Angeles, and Miami). Results indicated that the most frequently endorsed barriers to pain management were those regarding lack of knowledge about pain management or access to pain management experts, and concerns regarding potential substance abuse or addiction. Experience in the management of pain in patients with AIDS was inversely correlated with endorsement of barriers related to pain management expertise and concern regarding potential substance abuse. More experienced clinicians were significantly less likely to cite these factors as barriers to pain management. More knowledgeable respondents were significantly more likely to identify barriers to pain management and individuals with more conservative attitudes towards pain management were significantly more likely to cite substance abuse issues or medical concerns as barriers to pain management.
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PMID:Clinicians' perceptions of barriers to pain management in AIDS. 1051 42


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