Pain management of opioid-treated cancer patients in hospital settings in Denmark.

AIM

To evaluate the performance and quality of cancer pain management in hospital settings.

METHODS

Anaesthesiologists specialised in pain and palliative medicine studied pain management in departments of oncology and surgery. Study days were randomly chosen and patients treated with oral opioids were included. Information regarding pain aetiology and mechanisms, pain medications and opioid side effects were registered from the medical records and by examining patients. Pain intensity was assessed using the Brief Pain Inventory.

RESULTS

In total, 59 cancer patients were included. In 49 (83%) patients pain aetiology was assessed by the physicians of the departments of oncology and surgery. In only 19 (32%) patients they assessed pain mechanisms. The median oral morphine dose was 120 mg/day (range: 10-720 mg/day). Seventy-eight per cent of patients received opioids at adequate regular intervals according to the duration of action. In 88% of the patients supplemental short-acting oral opioids were given on demand and the median supplemental oral dose was 16.5% of the daily dose. Seven patients with neuropathic pain received adjuvant drugs, whereas six patients with non-neuropathic pain received adjuvant drugs. Regarding opioid side effects only constipation and nausea were treated in the majority of the patients. Average pain intensity in the last 24 h for the total number of patients (n=59) < or =5 cm was 88.1% (confidence interval 77.1-95.1).

CONCLUSION

Cancer pain was prevalent in opioid-treated patients in hospital settings: however, focussing on average pain intensity, the outcome seems favourable compared with other countries. Pain mechanisms were seldom examined and adjuvant drugs were not specifically used for neuropathic pain. Opioid dosing intervals and supplemental opioid doses were most often adequate. However, opioid side effects were highly prevalent and most side effects were left untreated.