title: Pain management and related factors in advanced cancer patients who initiated opioid therapy in an outpatient setting.
abstract: OBJECTIVE
  The aim of this study was to clarify the state of pain management in Japanese patients with advanced cancer who initiated opioid therapy in an outpatient setting.
  
  
  METHODS
  Interview surveys using questionnaires were conducted and medical records were reviewed. Pain relief was defined as >33% decrease in worst pain intensity score, and significance of early pain relief was investigated in terms of changing self-efficacy for activities of daily living (ADL). Factors related to early pain relief were also investigated.
  
  
  RESULTS
  The study was conducted between June and December 2003, on 20 patients (13 women, 7 men; mean age, 59 years). Compared to score at initiation of opioid administration (Numerical Rating Scale, 8.3 +/- 1.3), pain relief was generally insufficient at 2 weeks (early pain relief ratio was only 42%). Patients with sufficient pain relief at 2 weeks displayed significant improvements in numerous ADL functions and symptom-coping efficacy (p = 0.037), confirming the importance of early pain relief. Early pain relief was associated with high frequency of hospital visits before opioid administration and absence of sudden excavation within the first 2 weeks.
  
  
  CONCLUSIONS
  Result of this study indicated insufficient pain relief at an outpatients setting with advanced cancer patients. In the meantime, patients had who their pain decrease after 2 weeks also had improved ADL and self-efficacy at the same time. These findings suggest that to achieve early pain relief in an outpatient setting, clinical staff must assess pain earlier and inform patients of possible breakthrough pain following opioid administration and available treatments for such occurrences.
authors.affiliation: Pain control nurse, Outpatients nursing section, Keio University Hospital, 35 Shinanomatchi, Shinjuku-ku, Tokyo, 160-8582, Japan. nurseki@k3.dion.ne.jp
authors.forename: Rieko
authors.initials: R
authors.lastname: Kimura
authors.forename: Saori
authors.initials: S
authors.lastname: Hashiguchi
authors.forename: Masako
authors.initials: M
authors.lastname: Kawa
authors.forename: Mitsunori
authors.initials: M
authors.lastname: Miyashita
authors.forename: Tomoyo
authors.initials: T
authors.lastname: Sasahara
authors.forename: Yuki
authors.initials: Y
authors.lastname: Shirai
authors.forename: Keiko
authors.initials: K
authors.lastname: Kazuma
mesh_terms: D000328:Adult; D000368:Aged; D000553:Ambulatory Care; D000701:Analgesics, Opioid / Q000008:administration & dosage*; D001943:Breast Neoplasms / Q000503:physiopathology / Q000523:psychology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000503:physiopathology* / Q000523:psychology; D010146:Pain / Q000188:drug therapy*; D010147:Pain Measurement; D010166:Palliative Care / Q000523:psychology; D011788:Quality of Life / Q000523:psychology; D020377:Self Efficacy; D014041:Tokyo; D016896:Treatment Outcome
chemical_list: D000701:Analgesics, Opioid