title: A multicenter assessment of the adequacy of cancer pain treatment using the pain management index.
abstract: OBJECTIVE
  Determine adequacy of management of pain secondary to bone metastases by physicians referring to specialized outpatient palliative radiotherapy (RT) clinics in Canada; compare geographic differences in adequacy of pain management and pain severity between these cohorts; compare results with published international literature.
  
  
  METHODS
  Prospectively collected data from three participating centers were used to calculate the Pain Management Index (PMI) by subtracting the patient-rated pain score at time of initial clinic visit from the analgesic score. Scores were 0, 1, 2, and 3 when patients reported no pain (0), mild (1-4), moderate (5-6), or severe pain (7-10), respectively, on the Edmonton Symptom Assessment System or Brief Pain Inventory. Analgesic scores of 0, 1, 2, and 3 were assigned for no pain medication, nonopioids, weak opioids, and strong opioids respectively. A negative PMI suggests inadequate pain management.
  
  
  RESULTS
  Overall incidence of negative PMI and moderate to severe pain was 25.1% and 70.9% respectively for 2011 patients. Comparing the three participating centers, the incidence of negative PMI was 31.0%, 20.0%, and 16.8% (p < 0.0001), and severe pain was 55.5%, 48.2% and 43.4% (p < 0.0001), these correlated with a negative PMI. Patients referred to our clinics were less likely to be undertreated for their pain when compared to study results from international countries.
  
  
  CONCLUSIONS
  Geographic differences in adequacy of analgesic management for painful bone metastases exist between Canadian specialized outpatient palliative RT clinics and between centers globally. Investigating reasons for these differences may provide insight into solutions to improve quality of life for these patients.
authors.affiliation: Department of Radiation Therapy, Odette Cancer Center, University of Toronto, Toronto, Ontario, Canada. Gunita.Mitera@sunnybrook.ca
authors.forename: Gunita
authors.initials: G
authors.lastname: Mitera
authors.forename: Alysa
authors.initials: A
authors.lastname: Fairchild
authors.forename: Carlo
authors.initials: C
authors.lastname: DeAngelis
authors.forename: Urban
authors.initials: U
authors.lastname: Emmenegger
authors.forename: Laura
authors.initials: L
authors.lastname: Zurawel-Balaura
authors.forename: Liying
authors.initials: L
authors.lastname: Zhang
authors.forename: Andrea
authors.initials: A
authors.lastname: Bezjak
authors.forename: Wilfred
authors.initials: W
authors.lastname: Levin
authors.forename: Michael
authors.initials: M
authors.lastname: Mclean
authors.forename: Nadil
authors.initials: N
authors.lastname: Zeiadin
authors.forename: Jocelyn
authors.initials: J
authors.lastname: Pang
authors.forename: Janet
authors.initials: J
authors.lastname: Nguyen
authors.forename: Emily
authors.initials: E
authors.lastname: Sinclair
authors.forename: Edward
authors.initials: E
authors.lastname: Chow
authors.forename: Rebecca
authors.initials: R
authors.lastname: Wong
mesh_terms: D000368:Aged; D002170:Canada; D005260:Female; D006801:Humans; D008007:Licensure, Medical; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000150:complications*; D010146:Pain / Q000175:diagnosis / Q000209:etiology; D059408:Pain Management; D010147:Pain Measurement; D010166:Palliative Care; D011446:Prospective Studies; D011788:Quality of Life / Q000523:psychology; D012720:Severity of Illness Index; D016896:Treatment Outcome