title: Trajectories of pain and analgesics in oncology outpatients with metastatic bone pain.
abstract: A large proportion of oncology outpatients with bone metastasis report unrelieved pain that significantly interferes with daily functioning and quality of life. However, little is known about the longitudinal pattern of pain intensity and analgesic prescriptions or use. Moreover, despite considerable advantages, the use of sophisticated statistical techniques, such as hierarchical linear modeling (HLM) has not been applied to the study of pain and analgesic outcomes. In a prospective longitudinal study, HLM was used to explore predictors of pain intensity and analgesic prescription and intake at the time of enrollment into the study (intercept) and over the course of 6 weeks (trajectory) in a sample of oncology outpatients with bone metastasis who received standard care for pain. In addition to corroborating known predictors of pain intensity, previously unrecognized variables were found that appear to affect both pain and analgesic outcomes. Importantly, some of the predictors of the trajectories of pain intensity and analgesic use (ie, pain-related distress and Pain Management Index (PMI) scores) are particularly amenable to interventions. Findings from this study suggest that sophisticated statistical modeling can be used in pain research to identify individual risk factors and propose novel targets that can be used to improve pain management in oncology outpatients with bone metastasis.
  
  
  CONCLUSIONS
  Findings from this study suggest that a large amount of inter-individual variability exists in patients' experiences with cancer pain and analgesic use. Future studies need to elucidate the mechanisms that underlie these differences.
authors.affiliation: Department of Physiological Nursing, School of Nursing, University of California, San Francisco, California 94143-0610, USA.
authors.forename: Dale J
authors.initials: DJ
authors.lastname: Langford
authors.forename: Debu
authors.initials: D
authors.lastname: Tripathy
authors.forename: Steven M
authors.initials: SM
authors.lastname: Paul
authors.forename: Claudia
authors.initials: C
authors.lastname: West
authors.forename: Marylin J
authors.initials: MJ
authors.lastname: Dodd
authors.forename: Karen
authors.initials: K
authors.lastname: Schumacher
authors.forename: Christine
authors.initials: C
authors.lastname: Miaskowski
mesh_terms: D000700:Analgesics / Q000627:therapeutic use*; D001859:Bone Neoplasms / Q000150:complications* / Q000556:secondary; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010045:Outpatients / Q000706:statistics & numerical data*; D010146:Pain / Q000188:drug therapy* / Q000209:etiology; D010147:Pain Measurement; D016032:Randomized Controlled Trials as Topic; D016896:Treatment Outcome
chemical_list: D000700:Analgesics