measurement of cancer pain via patient self-report

Pain intensity is the main clinical variable in guiding management of cancer pain. Pain measurement scales should be psychometrically valid and practically feasible. One of the most common methods of pain measurement involves patient self-administration of forms, questionnaires, or pain diaries.

Full Answer

Do self-reporting pain assessment tools improve pain management in cancer patients?

The use of a self-reporting pain assessment tool as a communication instrument provides an effective foundation for evaluating pain intensity in cancer pain management. A more individualized approach to patient education about pain management may improve patient outcome.

Why is pain assessment important for cancer patients?

Untreated or undertreated pain directly affects quality of life and profoundly influences the patient's ability to endure treatment, return to health as a cancer survivor, or achieve a dignified death. For these reasons, reliable and comprehensive pain assessment is an essential first step for ideal cancer pain management.

Is cancer pain management underestimated?

Pain is common during cancer treatment, and patient self-reporting of pain is an essential first step for ideal cancer pain management. However, many studies on cancer pain management report that, because pain may be underestimated, it is often inadequately managed. Objective

What is the relationship between cancer and pain?

Pain weakens the body's resistance to infection (due to the deterioration of immunological competence). Most pain caused by cancer is sufficiently controllable through medication, so cancer-related pain should be treated actively. Do not fear the use of analgesic based on wrong ideas about pain.

What are self report measures of pain?

Over the last decade, self-reported scales have become the gold standard of pediatric pain assessment. They measure the intensity of the pain along a continuum from 'no pain' to 'worst pain' imaginable, either with numbers, faces, or graduated lines of colour.

How do you assess a patient's level of pain?

PQRST Pain Assessment MethodP = Provocation/Palliation. What were you doing when the pain started? ... Q = Quality/Quantity. What does it feel like? ... R = Region/Radiation. Where is the pain located? ... S = Severity Scale. ... T = Timing. ... Documentation.

What is an acceptable pain score?

There are many different kinds of pain scales, but a common one is a numerical scale from 0 to 10. Here, 0 means you have no pain; one to three means mild pain; four to seven is considered moderate pain; eight and above is severe pain.

What is the gold standard when monitoring pain in a patient?

The gold standard in pain evaluation is patient self-reporting, which is not always possible. Current research shows that the two tools best validated for patients unable to self-report pain are the Behavioral Pain Scale (BPS) and the Critical Care Pain Observation Tool (CPOT).

What are the 3 different assessment tools for pain?

Pain Assessment ScalesNumerical Rating Scale (NRS)Visual Analog Scale (VAS)Defense and Veterans Pain Rating Scale (DVPRS)Adult Non-Verbal Pain Scale (NVPS)Pain Assessment in Advanced Dementia Scale (PAINAD)Behavioral Pain Scale (BPS)Critical-Care Observation Tool (CPOT)

Is there a measurement for pain?

The visual analogue scale (VAS) and numeric rating scale (NRS) are most commonly used to assess the present intensity of acute pain. They are reliable, valid, sensitive to change, and easy to administer for measurement of severity of pain.

What is PQRST pain scale?

The mnemonic device PQRST offers one way to recall assessment:P. stands for palliative or precipitating factors, Q for quality of pain, R for region or radiation of pain, S for subjective descriptions of pain, and T for temporal nature of pain (the time the pain occurs).

What are the physical signs that a client is in pain?

Nonverbal Indicators of PainTense body language.Restlessness.Strained facial expressions.Sad facial expressions.Tearfulness.Increased resistance/agitation with movement.Increased breathing.Shortness of breath.

Background

Pain intensity is the main clinical variable in guiding management of cancer pain.

Methods

Patients referred to the Pain and Palliative Care inpatient consult service at the National Cancer Institute in Milan, Italy between 1/27/01 and 1/25/01 were eligible.

Results

Of the 174 patients seen during the study period, 106 (61%) were eligible for the study. The most common reason for exclusion was change in mental status (seen in 24 patients).

Authors' Conclusions

It is not known what the best administration modality is for pain assessment; however, any scale that is chosen should follow specific guidelines and be appropriate for the long-term monitoring of cancer pain therapies.

Discussion

Pain has a high impact on the quality of life of many cancer patients. In light of the extremely subjective nature of pain, patient self-assessment is vital to guiding pain management.

What is the pain assessment for cancer?

For persons with cancer who are able to self-report, a pain assessment usually begins with a simple screening question, “Are you having any pain or discomfort?” Affirmative responses warrant a more comprehensive assessment based on the patient's age, ability to self-report, and clinical resources. 27 Various mnemonics (OLDCART, 28 PQRST, 29 and WILDA 30) are available to assist the clinician to remember key aspects of a pain assessment ( Table 3 ). The WILDA approach incorporates five key components and begins with an open-ended question, “Tell me about your pain,” guiding the nurse to ask about the words used to describe pain, intensity, location, duration, and aggravating or alleviating factors. 30 For patients with cancer experiencing acute procedural pain, well-validated pain intensity scales are available for patients able to rate discomforts. 31 Commonly used pain intensity scales include the numeric rating scale (NRS), verbal descriptor scale (VDS), Wong–Baker FACES pain scale, and Faces Pain Scale-Revised (FPS-R). 32., 33. Using a pain intensity scale facilitates communication among the patient, family, and clinician to measure the patient's response to both pharmacologic and non-pharmacologic strategies. When patients are unable to provide a “0 to 10” response because of a language barrier, having access to culturally tailored pain intensity scales in multiple languages is helpful.

How common is cancer pain?

Pain can be common and distressing for persons with cancer across the illness continuum. According to a 2016 meta-analysis and systematic review, cancer pain prevalence is 39% in cancer survivors post treatment; 55% when receiving anticancer therapy; and 66% with metastatic disease or at the end of life. Regardless of cancer stage, 51% of patients ...

Why is cancer pain so challenging?

Cancer Pain Assessment. Assessment of cancer-related pain is challenging because of the subjective nature of pain and the complexity of the underlying disease. As mentioned previously, most cancer patients with advanced disease deal with significant pain. Cancer pain also results from the underlying disease, is secondary to antineoplastic therapy, ...

What is temporal pain?

Temporality considers the experience of pain over time for the individual, including the onset and duration of pain. Pain can be intermediate, constant, or breakthrough. Intermediate pain occurs occasionally, whereas chronic pain occurs all the time.

What is breakthrough pain?

Breakthrough pain, as noted earlier, is an acute exacerbation of pain that occurs with well-controlled background pain and requires further evaluation.11. Because pain is inherently subjective, patient self-report is the current standard for assessment.

Why should the patient's goals for comfort and desired level of function be obtained and documented?

The patient's goals for comfort (the level of pain that would be tolerable to them) and desired level of function should be obtained and documented because the goal will be to help the patient to achieve this level of pain relief. 15.

Why is pain assessment not a priority?

Because diagnosing and managing cancer are main concerns in clinical settings , pain assessment often is not a priority for both health care professionals and patients. The consequence is the lack of knowledge and understanding of the patient's pain problem.

Abstract

A consecutive sample of 53 chronic cancer pain patients were administered 5 different pain intensity scales: a visual analogue scale (VAS), a numerical rating scale from 0 to 10 (NRS), a verbal rating scale (VRS), the Italian Pain Questionnaire (Italian version of the McGill Pain Questionnaire) (PRI), and the Integrated Pain Score (IPS) which is an instrument designed at the Pain Therapy and Palliative Care Division of the National Cancer Institute of Milan to integrate pain intensity and duration in a single measure.

Keywords

Puin, 57 (l W) K) l -l Ah Eisevier Science B.V. Kil PAIN 24.SI Pain measurement in cancer patients: a comparison of six methods Franco De Conno '' , Augusto Caraceni , Alessio Gamba , Luigi Mariani c, Antoncllo Ahbattista c. Cinzia Brunelli d, Angela La Mura and Vittorio Vcntafridda '' " Puin Therapy anil Palliuiii r Care Din.'iion.

What is pain in medical terms?

Pain has been defined as an “unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage.”#N#5#N#,#N#6#N#The International Association for the Study of Pain has called unrelieved pain “a major global healthcare problem.”#N#7

How does pain affect sleep?

Pain interferes with sleep, makes activities of daily living more difficult, limits social engagement, and is financially burdensome to individuals and their families (see, for example, references 11–15). Furthermore, pain causes changes in neural function that outlast the precipitating disease or injury.

Is pain a sensory function?

In the International Classification of Functioning, Disability and Health, sensory functions and pain are grouped together as body functions; however, sensation of pain is distinguished from sensory functions such as proprioception or touch , as well as functions related to temperature and other stimuli. 1.

Summary

Regular pain assessment and pain management should have the highest priority in the routine care of the patient with cancer. Between 60% and 80% of patients with advanced cancer will need pain treatment. Pain is also a problem for many patients early and intermittently during the course of their disease.

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)