Factors related to pain management adequacy in patients receiving palliative care: data from a tertiary hospital in Indonesia
DOI:
https://doi.org/10.13181/mji.oa.204088Keywords:
adequacy factors, pain management, palliative careAbstract
BACKGROUND Adequate pain management must be applied to improve the quality of life, particularly in patients receiving palliative care. Thus, this study aimed to determine the factors related to pain management adequacy in patients receiving palliative care.
METHODS This cross-sectional study included all patients sent for consultation to the palliative care team complaining of pain in Cipto Mangunkusumo Hospital, Jakarta, Indonesia from 2016 to 2018. All data such as gender, age, employment status, disease type, primary cancer location, pain intensity, analgesic drug treatment duration, and the presence of anxiety and depression were retrieved from medical records. Pain management adequacy was evaluated using the pain management index. Logistic regression included all variables with p<0.25 related to pain management adequacyin bivariate analysis.
RESULTS Out of 175 patients with pain, 85.7% reported having adequate pain management. Pain was more adequately treated in patients with employment (p = 0.001), milder pain intensity (p<0.001), those using opioids (p<0.001), and those who did not experience anxiety (p = 0.05). Factors related to pain management adequacy were opioid use (OR = 3.23, 95% CI = 1.71–6.13) and milder pain (OR = 11.15, 95% CI = 3.89–31.99).
CONCLUSIONS Most of the patients received adequate pain management which related to opioid use and milder pain.
Downloads
References
Wilkie DJ, Ezenwa MO. Pain and symptom management in palliative care and at end of life. Nurs Outlook. 2012;60(6):357-64. https://doi.org/10.1016/j.outlook.2012.08.002
ElMokhallalati Y, Woodhouse N, Farragher T, Bennett MI. Specialist palliative care support is associated with improved pain relief at home during the last 3 months of life in patients with advanced disease: analysis of 5-year data from the national survey of bereaved people (VOICES). BMC Med. 2019;17(1):50. https://doi.org/10.1186/s12916-019-1287-8
Chan HK, Ismail S. Side effects of chemotherapy among cancer patients in a Malaysian General Hospital: experiences, perceptions and informational needs from clinical pharmacists. Asian Pac J Cancer Prev. 2014;15(13):5305-9. https://doi.org/10.7314/APJCP.2014.15.13.5305
Sholjakova M, Durnev V, Kartalov A, Kuzmanovska B. Pain relief as an integral part of the palliative care. Open Access Maced J Med Sci. 2018;6(4):739-41. https://doi.org/10.3889/oamjms.2018.163
Vargas-Schaffer G. Is the WHO analgesic ladder still valid? Twenty-four years of experience. Can Fam Physician. 2010;56(6):514-7.
Bhatnagar S, Gupta M. Integrated pain and palliative medicine model. Ann Palliat Med. 2016;5(3):196-208. https://doi.org/10.21037/apm.2016.05.02
Kittelson SM, Elie MC, Pennypacker L. Palliative care symptom management. Crit Care Nurs Clin N Am. 2015;27:315-39. https://doi.org/10.1016/j.cnc.2015.05.010
Rasor J, Harris G. Opioid use for moderate to severe pain. J Am Osteopath Assoc. 2005;105(6):S2-7.
Krashin D, Murinova N, Jumelle P, Ballantyne J. Opioid risk assessment in palliative medicine. Expert Opin Drug Saf. 2015;14(7):1023-33. https://doi.org/10.1517/14740338.2015.1041915
Leppert W, Zajaczkowska R, Wordliczek J. The role of oxycodone/naloxone in the management of patients with pain and opioid-induced constipation. Expert Opin Pharmacother. 2019;20(5):5111-22. https://doi.org/10.1080/14656566.2018.1561863
Ho KY, Gwee KA, Cheng YK, Yoon KH, Hee HT, Omar AR. Nonsteroidal anti-inflammatory drugs in chronic pain: implications of new data for clinical practice. J Pain Res. 2018;11:1937-48. https://doi.org/10.2147/JPR.S168188
Derry S, Wiffen PJ, Moore RA, McNicol ED, Bell RF, Carr DB, et al. Oral nonsteroidal anti-inflammatory drugs (NSAIDs) for cancer pain in adults. Cochrane Database Syst Rev. 2017;7(7):CD012638. https://doi.org/10.1002/14651858.CD012638.pub2
Schüchen RH, Mücke M, Marinova M, Kravchenko D, Häuser W, Radbruch L, et al. Systematic review and meta-analysis on nonopioid analgesics in palliative medicine. J Cachexia Sarcopenia Muscle. 2018;9(7):1235-54. https://doi.org/10.1002/jcsm.12352
Klepstad P, Kaasa S, Borchgrevink PC. Starting step III opioids for moderate to severe pain in cancer patients: dose titration: a systematic review. Palliat Med. 2010;25(5):424-30. https://doi.org/10.1177/0269216310386280
Cohen B, Ruth LJ, Preuss CV. Opioid analgesics. Treasure Island: StatPearls Publishing; 2020. p. 1-13.
Ortiz MI, Molina MA, Arai YC, Romanò CL. Analgesic drugs combinations in the treatment of different types of pain. Pain Res Treat. 2012;2012:612519. https://doi.org/10.1155/2012/612519
Paterson C, Ledgerwood K, Arnold C, Hogg M, Xue C, Zheng Z. Resisting prescribed opioids: a qualitative study of decision making in patients taking opioids for chronic noncancer pain. Pain Med. 2016;17(4):717-27. https://doi.org/10.1111/pme.12921
Leppert W. Pain management in patients with cancer: focus on opioid analgesics. Curr Pain Headache Rep. 2011;15(4):271-9. https://doi.org/10.1007/s11916-011-0201-7
Prommer EE. Pharmacological management of cancer-related pain. Cancer Control. 2015;22(4):412-25. https://doi.org/10.1177/107327481502200407
Wandner LD, Scipio CD, Hirsh AT, Torres CA, Robinson ME. The perception of pain in others: how gender, race, and age influence pain expectations. J Pain. 2012;13(3):220-7. https://doi.org/10.1016/j.jpain.2011.10.014
Singh H, Banipal RPS, Singh B. Assessment of adequacy of pain management and analgesic use in patients with advanced cancer using the brief pain inventory and pain management index calculation. J Glob Oncol. 2016;3(3):235-41. https://doi.org/10.1200/JGO.2016.004663
Katz N. The impact of pain management on quality of life. J Pain Symptom Manage. 2002;24(1 Suppl):S38-47. https://doi.org/10.1016/S0885-3924(02)00411-6
Woo AK. Depression and anxiety in pain. Rev Pain. 2010;4(1):8-12. https://doi.org/10.1177/204946371000400103
Published
How to Cite
Issue
Section
License
Authors who publish with Medical Journal of Indonesia agree to the following terms:
- Authors retain copyright and grant Medical Journal of Indonesia right of first publication with the work simultaneously licensed under a Creative Commons Attribution-NonCommercial License that allows others to remix, adapt, build upon the work non-commercially with an acknowledgment of the work’s authorship and initial publication in Medical Journal of Indonesia.
- Authors are permitted to copy and redistribute the journal's published version of the work non-commercially (e.g., post it to an institutional repository or publish it in a book), with an acknowledgment of its initial publication in Medical Journal of Indonesia.
