title: A systematic review on barriers hindering adequate cancer pain management and interventions to reduce them: a critical appraisal.
abstract: The aim of this paper is to identify the major barriers hindering adequate pain management and critically review interventions aiming to overcome them. We searched relevant literature on PubMed published between January 1986 and April 2007. The most frequently mentioned barriers for both patients and professionals were knowledge deficits, inadequate pain assessment and misconceptions regarding pain. Four interventions were identified: patient education, professional education, pain assessment and pain consultation. These interventions were never combined in multidisciplinary study protocols. Most RCTs included small groups of patients and reported no power analysis. Studies on professional education and pain assessment did not evaluate patients' outcomes. In 5 of 11 RCTs on patient education, pain intensity decreased statistically significantly. In two RCTs on pain consultation, patients' pain decreased statistically significantly, although the adequacy of pain treatment did not change. In conclusion, international guidelines on multidisciplinary interventions in pain management are partly substantiated by clinical trials.
authors.affiliation: Department of Medical Oncology, Erasmus MC, P.O. Box 5201, 3008 AE Rotterdam, The Netherlands.
authors.forename: Wendy H
authors.initials: WH
authors.lastname: Oldenmenger
authors.forename: Peter A E
authors.initials: PA
authors.lastname: Sillevis Smitt
authors.forename: Silvia
authors.initials: S
authors.lastname: van Dooren
authors.forename: Gerrit
authors.initials: G
authors.lastname: Stoter
authors.forename: Carin C D
authors.initials: CC
authors.lastname: van der Rijt
mesh_terms: D000698:Analgesia / Q000379:methods*; D019317:Evidence-Based Medicine; D006801:Humans; D009369:Neoplasms / Q000523:psychology*; D010147:Pain Measurement / Q000379:methods; D010347:Patient Care Planning; D010353:Patient Education as Topic; D018802:Patient-Centered Care; D016032:Randomized Controlled Trials as Topic