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Previous Volume 330:592-596 March 3, 1994 Number 9 Next

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ABSTRACT

Background and Methods Pain is often inadequately treated in patients with cancer. A total of 1308 outpatients with metastatic cancer from 54 treatment locations affiliated with the Eastern Cooperative Oncology Group rated the severity of their pain during the preceding week, as well as the degree of pain-related functional impairment and the degree of relief provided by analgesic drugs. Their physicians attributed the pain to various factors, described its treatment, and estimated the impact of pain on the patients' ability to function. We assessed the adequacy of prescribed analgesic drugs using guidelines developed by the World Health Organization, studied the factors that influenced whether analgesia was adequate, and determined the effects of inadequate analgesia on the patients' perception of pain relief and functional status.

Results Sixty-seven percent of the patients (871 of 1308) reported that they had had pain or had taken analgesic drugs daily during the week preceding the study, and 36 percent (475 of 1308) had pain severe enough to impair their ability to function. Forty-two percent of those with pain (250 of the 597 patients for whom we had complete information) were not given adequate analgesic therapy. Patients seen at centers that treated predominantly minorities were three times more likely than those treated elsewhere to have inadequate pain management. A discrepancy between patient and physician in judging the severity of the patient's pain was predictive of inadequate pain management (odds ratio, 2.3). Other factors that predicted inadequate pain management included pain that physicians did not attribute to cancer (odds ratio, 1.9), better performance status (odds ratio, 1.8), age of 70 years or older (odds ratio, 2.4), and female sex (odds ratio, 1.5). Patients with less adequate analgesia reported less pain relief and greater pain-related impairment of function.

Conclusions Despite published guidelines for pain management, many patients with cancer have considerable pain and receive inadequate analgesia.

Source Information

From the Pain Research Group, Department of Neurology (C.S.C.), and University of Wisconsin Comprehensive Cancer Center (C.S.C., J.A.S.), Madison; Dana-Farber Cancer Institute, Boston (R.G.); Carle Cancer Center, Urbana, Ill. (A.K.H.); Mayo Clinic, Rochester, Minn. (J.H.E.); New York University Medical Center, New York (R.H.B.); and the University of Rochester Cancer Center, Rochester, N.Y. (K.J.P.).

Address reprint requests to Dr. Cleeland at the Pain Research Group, 1900 University Ave., Madison, WI 53705-4013.

Full Text of this Article

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Extract | Full Text  
N Engl J Med 1994; 331:199-201, Jul 21, 1994. Correspondence

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• Riley-Doucet, C. (2005). Beliefs About the Controllability of Pain: Congruence Between Older Adults With Cancer and Their Family Caregivers. Journal of Family Nursing 11: 225-241 [Abstract]  
• Weisbord, S. D., Fried, L. F., Arnold, R. M., Fine, M. J., Levenson, D. J., Peterson, R. A., Switzer, G. E. (2005). Prevalence, Severity, and Importance of Physical and Emotional Symptoms in Chronic Hemodialysis Patients. J. Am. Soc. Nephrol. 16: 2487-2494 [Abstract] [Full Text]  
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• Gilron, I., Bailey, J. M. (2003). Trends in opioid use for chronic neuropathic pain: a survey of patients pursuing enrollment in clinical trials: [Evolution de l'usage des opioides contre la douleur neuropathique chronique : une enquete aupres de patients voulant participer a des essais cliniques]. Canadian J. Anesthesia 50: 42-47 [Abstract] [Full Text]  
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• Esnaola, N. F., Cantor, S. B., Johnson, M. L., Mirza, A. N., Miller, A. R., Curley, S. A., Crane, C. H., Cleeland, C. S., Janjan, N. A., Skibber, J. M. (2002). Pain and Quality of Life After Treatment in Patients With Locally Recurrent Rectal Cancer. JCO 20: 4361-4367 [Abstract] [Full Text]  
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• Byock, I. (2002). Dying Well in Corrections: Why Should We Care?. JOURNAL OF CORRECTIONAL HEALTH CARE 9: 107-117 [Abstract]  
• Callstrom, M. R., Charboneau, J. W., Goetz, M. P., Rubin, J., Wong, G. Y., Sloan, J. A., Novotny, P. J., Lewis, B. D., Welch, T. J., Farrell, M. A., Maus, T. P., Lee, R. A., Reading, C. C., Petersen, I. A., Pickett, D. D. (2002). Painful Metastases Involving Bone: Feasibility of Percutaneous CT- and US-guided Radio-frequency Ablation. Radiology 224: 87-97 [Abstract] [Full Text]  
• WATKINS, C. A., LOGAN, H. L., KIRCHNER, H. L. (2002). Anticipated and experienced pain associated with endodontic therapy. Journal of the American Dental Association 133: 45-54 [Abstract] [Full Text]  
• Landi, F., Onder, G., Cesari, M., Gambassi, G., Steel, K., Russo, A., Lattanzio, F., Bernabei, R., for the SILVERNET-HC Study Group, (2001). Pain Management in Frail, Community-Living Elderly Patients. Arch Intern Med 161: 2721-2724 [Abstract] [Full Text]  
• Chodosh, J., Ferrell, B. A., Shekelle, P. G., Wenger, N. S. (2001). Quality Indicators for Pain Management in Vulnerable Elders. ANN INTERN MED 135: 731-735 [Full Text]  
• Knab, J. H., Wallace, M. S., Wagner, R. L., Tsoukatos, J., Weinger, M. B. (2001). The Use of a Computer-Based Decision Support System Facilitates Primary Care Physicians' Management of Chronic Pain. Anesth. Analg. 93: 712-720 [Abstract] [Full Text]  
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• Roscoe, L. A., Malphurs, J. E., Dragovic, L. J., Cohen, D. (2001). A Comparison of Characteristics of Kevorkian Euthanasia Cases and Physician-Assisted Suicides in Oregon. Gerontologist 41: 439-446 [Abstract] [Full Text]  
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• Smith, T. J., Hillner, B. E. (2001). Ensuring Quality Cancer Care by the Use of Clinical Practice Guidelines and Critical Pathways. JCO 19: 2886-2897 [Abstract] [Full Text]  
• May, J. A., White, H. C., Leonard-White, A., Warltier, D. C., Pagel, P. S. (2001). The Patient Recovering from Alcohol or Drug Addiction: Special Issues for the Anesthesiologist. Anesth. Analg. 92: 1601-1608 [Full Text]  
• Herndon, C. M., Fike, D. S., Anderson, A. C., Dole, E. J. (2001). Pharmacy student training in United States hospices. AM J HOSP PALLIAT CARE 18: 181-186 [Abstract]  
• Oliver, J. W., Kravitz, R. L., Kaplan, S. H., Meyers, F. J. (2001). Individualized Patient Education and Coaching to Improve Pain Control Among Cancer Outpatients. JCO 19: 2206-2212 [Abstract] [Full Text]  
• Casarett, D., Abrahm, J. L. (2001). Patients With Cancer Referred to Hospice Versus a Bridge Program: Patient Characteristics, Needs for Care, and Survival. JCO 19: 2057-2063 [Abstract] [Full Text]  
• Rhodes, D. J., Koshy, R. C., Waterfield, W. C., Wu, A. W., Grossman, S. A. (2001). Feasibility of Quantitative Pain Assessment in Outpatient Oncology Practice. JCO 19: 501-508 [Abstract] [Full Text]  
• Saha, S., Leemis, R. H., Holdsworth, M. T., Anderson, J. R., Raisch, D. W., Hermos, J. A., Gilson, S. B., Morrison, R. S., Wallenstein, S., Freeman, H. P., Payne, R. (2000). "We Don't Carry That". NEJM 343: 442-445 [Full Text]  
• Anderson, R., Saiers, J. H., Schlicht, C., Abram, S. (2000). Continuous infusion sufentanil for malignant pain: A case report. AM J HOSP PALLIAT CARE 17: 265-268  
• Rogers, M S, Todd, C J (2000). The 'right kind' of pain: talking about symptoms in outpatient oncology consultations. Palliat Med 14: 299-307 [Abstract]  
• Morrison, R. S., Wallenstein, S., Natale, D. K., Senzel, R. S., Huang, L.-L. (2000). "We Don't Carry That" -- Failure of Pharmacies in Predominantly Nonwhite Neighborhoods to Stock Opioid Analgesics. NEJM 342: 1023-1026 [Abstract] [Full Text]  
• Morrison, R. S., Siu, A. L., Leipzig, R. M., Cassel, C. K., Meier, D. E. (2000). The Hard Task of Improving the Quality of Care at the End of Life. Arch Intern Med 160: 743-747 [Full Text]  
• Faber-Langendoen, K., Karlawish, J. H.T., for the University of Pennsylvania Center for Bioe, (2000). Should Assisted Suicide Be Only Physician Assisted?. ANN INTERN MED 132: 482-487 [Abstract] [Full Text]  
• Duggleby, W. (2000). Elderly hospice cancer patients' descriptions of their pain experiences. AM J HOSP PALLIAT CARE 17: 111-117 [Abstract]  
• Wolfe, J., Grier, H. E., Klar, N., Levin, S. B., Ellenbogen, J. M., Salem-Schatz, S., Emanuel, E. J., Weeks, J. C. (2000). Symptoms and Suffering at the End of Life in Children with Cancer. NEJM 342: 326-333 [Abstract] [Full Text]  
• Gloth, F. M. III, Schwartz, J. (2000). Developing a physicians' palliative care pain hotline in Maryland. AM J HOSP PALLIAT CARE 17: 24-28 [Abstract]  
• Nekolaichuk, C. L., Maguire, T. O., Suarez-Almazor, M., Rogers, W. T., Bruera, E. (1999). Assessing the Reliability of Patient, Nurse, and Family Caregiver Symptom Ratings in Hospitalized Advanced Cancer Patients. JCO 17: 3621-3630 [Abstract] [Full Text]  
• Seely, J. F., Mount, B. M. (1999). Palliative medicine and modern technology. CMAJ 161: 1120-1121 [Full Text]  
• Jain, S., Datta, S., Tundis, D. (1999). Management of Chronic Postthoracotomy Pain. SEMIN CARDIOTHORAC VASC ANESTH 3: 191-203 [Abstract]  
• Bruera, E., Neumann, C. M., Gagnon, B., Brenneis, C., Kneisler, P., Selmser, P., Hanson, J. (1999). Edmonton Regional Palliative Care Program: impact on patterns of terminal cancer care. CMAJ 161: 290-293 [Abstract] [Full Text]  
• Rochon, P. A., Gurwitz, J. H. (1999). Prescribing for Seniors: Neither Too Much nor Too Little. JAMA 282: 113-115 [Full Text]  
• Abrahm, J. L., for the ACP-ASIM End-of-Life Care Consensus Panel, (1999). Management of Pain and Spinal Cord Compression in Patients with Advanced Cancer. ANN INTERN MED 131: 37-46 [Abstract] [Full Text]  
• Carver, A. C., Vickrey, B. G., Bernat, J. L., Keran, C., Ringel, S. P., Foley, K. M. (1999). End-of-life care: A survey of US neurologists' attitudes, behavior, and knowledge. Neurology 53: 284-284 [Abstract] [Full Text]  
• Nekolaichuk, C. L, Bruera, E., Spachynski, K., MacEachern, T., Hanson, J., Maguire, T. O (1999). A comparison of patient and proxy symptom assessments in advanced cancer patients. Palliat Med 13: 311-323 [Abstract]  
• Lo, B., Snyder, L., Sox, H. C. (1999). Care at the End of Life: Guiding Practice Where There Are No Easy Answers. ANN INTERN MED 130: 772-774 [Full Text]  
• de Wit, R., van Dam, F., Abu-Saad, H. H., Loonstra, S., Zandbelt, L., van Buuren, A., van der Heijden, K., Leenhouts, G. (1999). Empirical Comparison of Commonly Used Measures to Evaluate Pain Treatment in Cancer Patients With Chronic Pain. JCO 17: 1280-1280 [Abstract] [Full Text]