title: Routine screening for pain combined with a pain treatment protocol in head and neck cancer: a randomised controlled trial.
abstract: BACKGROUND
  We compared the effectiveness and cost of a pain screening and treatment program, with usual care in head and neck cancer patients with significant pain.
  
  
  METHODS
  Patients were screened for the presence of pain and then randomly assigned to either an intervention group, consisting of a pain treatment protocol and an education program, or to usual care. Primary outcome was change in the Pain Severity Index (PSI) over three months.
  
  
  RESULTS
  We screened 1074 patients of whom 156 were randomized to either intervention or usual care. Mean PSI was reduced over three months in both groups, with no significant difference between the two groups. The Pain Management Index (PMI) at three months, was significantly improved in the intervention group compared with usual care (P<0.001), as was Patient Satisfaction (mean difference in scores was statistically significant: -0.30 [-0.60 to -0.15]). All subjects reported clinically significant levels of anxiety and depression throughout the study. Treatment costs were significantly higher for intervention (mean=£400) compared with usual care (£200), with a low likelihood of being cost-effective.
  
  
  CONCLUSIONS
  There was no difference in the Pain Severity Index between the two groups. However there were significant improvements in the intervention group in patient satisfaction and PMI. The pain screening process itself was effective. Sufficient benefit was demonstrated as a result of the intervention to allow continued development of pain treatment pathways, rather than allowing pain treatment to be left to nonformalised ad hoc arrangements.
authors.affiliation: Department of Anaesthetics and Pain Management, Royal Marsden NHS Foundation Trust, London, UK john.williams@rmh.nhs.uk.
authors.forename: J E
authors.initials: JE
authors.lastname: Williams
authors.affiliation: Division of Health and Social Care Research, King's College, London, UK NIHR Biomedical Research Centre at Guy's and St Thomas' NHS Foundation Trust, and King's College, London, UK.
authors.forename: J
authors.initials: J
authors.lastname: Peacock
authors.affiliation: Department of Anaesthetics and Pain Management, Royal Marsden NHS Foundation Trust, London, UK.
authors.forename: A N
authors.initials: AN
authors.lastname: Gubbay
authors.affiliation: Department of Anaesthetics and Pain Management, Royal Marsden NHS Foundation Trust, London, UK.
authors.forename: P Y
authors.initials: PY
authors.lastname: Kuo
authors.affiliation: Department of Anaesthetics and Pain Management, Royal Marsden NHS Foundation Trust, London, UK.
authors.forename: R
authors.initials: R
authors.lastname: Ellard
authors.affiliation: Department of Anaesthetics and Pain Management, Royal Marsden NHS Foundation Trust, London, UK.
authors.forename: R
authors.initials: R
authors.lastname: Gupta
authors.affiliation: Department of Palliative Medicine, Royal Marsden NHS Foundation Trust, London, UK.
authors.forename: J
authors.initials: J
authors.lastname: Riley
authors.affiliation: AG Epidemiologie & International Public Health, Universität Bielefeld, Bielefeld, Germany.
authors.forename: O
authors.initials: O
authors.lastname: Sauzet
authors.affiliation: Dept. of Health Economics, University of Southampton, UK.
authors.forename: J
authors.initials: J
authors.lastname: Raftery
authors.affiliation: Department of Primary Care and Population Science, University of Southampton, UK.
authors.forename: G
authors.initials: G
authors.lastname: Yao
authors.affiliation: Department of Palliative Medicine, Royal Marsden NHS Foundation Trust, London, UK National Heart and Lung Institute, Imperial College, London, UK.
authors.forename: J
authors.initials: J
authors.lastname: Ross
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002985:Clinical Protocols; D005260:Female; D006258:Head and Neck Neoplasms / Q000150:complications* / Q000191:economics; D017048:Health Care Costs / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D010146:Pain / Q000175:diagnosis* / Q000191:economics / Q000209:etiology*; D059408:Pain Management / Q000191:economics / Q000379:methods*; D010353:Patient Education as Topic / Q000191:economics / Q000379:methods; D012720:Severity of Illness Index; D055815:Young Adult
keywords: cancer; pain; screening