Pain and pain alleviation in hospital-based home care: demographic, biological and treatment factors.
The aim of this study was to contrast two opposed groups, namely palliative cancer patients who were suffering significant pain (VAS> or =4) and palliative cancer patients with no pain (VAS = 0) in hospital-based home care and, retrospectively, to study possible differences in relation to demographic, biological and treatment factors. The ESAS (Edmonton Symptom Assessment Scale) was used to assess 191 palliative cancer patients on admission and after 1 week of home care. Fifty-two (27%) had pain (mean 5.5+/-1.7) and 72 (38%) had no pain on admission [the middle group (n=67) had VAS 1-3]. Activity was more severely affected (5.4 vs 4.2, p<0.01) and nausea less well controlled in patients with pain (2.3 vs 0.7, P<0.0001). Pain was associated with the diagnosis of prostate cancer (P<0.01) and the presence of skeletal metastases (P<0.001), whereas pain-free patients, with or without analgesics, more often had colorectal cancer (P<0.01) or melanoma (P<0.05). The medication profiles differed between the two groups: 22 (42%) of the 52 patients with pain were on step 3 of the WHO analgesic ladder and 24 of 51 (47%) were receiving antiemetics, whereas 42 (58%) of the 72 patients with no current pain had no analgesic prescribed and only 25% of them had antiemetics prescribed, indicating biological differences. If pain was present on admission a pain analysis was formally documented in 23 (44%) of the 52 cases and the medication was changed in 27 of the 52 (52%). The patients improved after 1 week (5.4+/-1.6 vs 3.9+/-2.3, P<0.001), and the improvement was significant even when a pain analysis was not documented or when medication was not changed. In conclusion, the results of this study indicate biological differences in pain alleviation and the need for a more structured way of working.
Heedman
Per-Anders
PA
Palliative Advisory Team, Linköping University Hospital, 58185 Linköping, Sweden. per-anders.heedman@lio.se
Strang
Peter
P
D000368:Aged; D000369:Aged, 80 and over; D000701:Analgesics, Opioid / Q000627:therapeutic use; D001859:Bone Neoplasms / Q000150:complications / Q000556:secondary; D015179:Colorectal Neoplasms / Q000150:complications; D003710:Demography; D005260:Female; D006699:Home Care Services; D006801:Humans; D008297:Male; D008545:Melanoma / Q000150:complications; D008875:Middle Aged; D009369:Neoplasms / Q000150:complications*; D010146:Pain / Q000188:drug therapy* / Q000209:etiology; D010147:Pain Measurement; D010166:Palliative Care; D011471:Prostatic Neoplasms / Q000150:complications; D012878:Skin Neoplasms / Q000150:complications
D000701:Analgesics, Opioid