Barriers to Pain Management among Lithuanian Cancer Patients

Jacobsen, Ramunė; Samsanaviciene, Jurgita; Liuabarskiene, Zita; Ščiupokas, Arūnas

doi:10.1111/j.1533-2500.2009.00333.x

Cited by 22 publications

(18 citation statements)

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“…Various cognitive and educational barriers among patients may interfere with pain management by reducing adherence with treatment regimens [81,82]. Suggested components of public education include how to prevent common types of pain, how and when patients should self-treat pain, when patients should consult a doctor, what they can expect from therapy and how they can access further forms of support.…”

Section: Discussionmentioning

confidence: 99%

The individual and societal burden of chronic pain in Europe: the case for strategic prioritisation and action to improve knowledge and availability of appropriate care

2013

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BackgroundChronic pain is common in Europe and elsewhere and its under treatment confers a substantial burden on individuals, employers, healthcare systems and society in general. Indeed, the personal and socioeconomic impact of chronic pain is as great as, or greater, than that of other established healthcare priorities. In light of review of recently published data confirming its clinical and socioeconomic impact, this paper argues that chronic pain should be ranked alongside other conditions of established priority in Europe. We outline strategies to help overcome barriers to effective pain care resulting in particular from deficiencies in education and access to interdisciplinary pain management services. We also address the confusion that exists between proper clinical and scientific uses of opioid medications and their potential for misuse and diversion, as reflected in international variations in the access to, and availability of, these agents.DiscussionAs the economic costs are driven in part by the costs of lost productivity, absenteeism and early retirement, pain management should aim to fully rehabilitate patients, rather than merely to relieve pain. Accredited education of physicians and allied health professionals regarding state-of-the-art pain management is crucial. Some progress has been made in this area, but further provision and incentivization is required. We support a tiered approach to pain management, whereby patients with pain uncontrolled by non-specialists are able to consult a physician with a pain competency or a specialist in pain medicine, who in turn can recruit the services of other professionals on a case-by-case basis. A fully integrated interdisciplinary pain service should ideally be available to patients with refractory pain. Governments and healthcare systems should ensure that their policies on controlled medications are balanced, safeguarding public health without undue restrictions that compromise patient care, and that physician education programmes support these aims.SummaryStrategic prioritization and co-ordinated actions are required nationally and internationally to address the unacceptable and unnecessary burden of uncontrolled chronic pain that plagues European communities and economies. An appreciation of the ‘return on investment’ in pain management services will require policymakers to adopt a long-term, cross-budgetary approach.

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Section: Discussionmentioning

confidence: 99%

The individual and societal burden of chronic pain in Europe: the case for strategic prioritisation and action to improve knowledge and availability of appropriate care

2013

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“…Similarly, several trials have reported a positive correlation between depression and some subscales of the barrier score or the total barrier score [4, 5, 8, 31], and one [5] of these studies suggested that depression was a predictor of high barrier score to pain management. In our study population, we found that patients with depression (25 %) had more severe pain, more interfering symptoms, and poorer quality of life than did those without depression ( p < 0.05).…”

Section: Discussionmentioning

confidence: 99%

“…Numerous patient-related [4–9], systematic [10, 11], and professional [12, 13] barriers are encountered in managing cancer pain. One type of patient-related barrier that may be a major contributor to poor pain control is the patient’s perspective about pain medication, which could include concerns about addiction, adverse effects, drug tolerance, the harmful effects of opioids, and distracting physicians from providing cancer treatment [5, 6, 8, 14, 15].…”

Section: Introductionmentioning

confidence: 99%

Predictors of high score patient-reported barriers to controlling cancer pain: a preliminary report

Kwon

Chisholm

et al. 2012

Support Care Cancer

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Purpose Pain is one of the most common and devastating symptoms in cancer patients, and misunderstandings on the patient’s part can cause major obstacles in pain management. Method We evaluated factors associated with patient’s high barrier score to managing cancer-associated pain by having 201 patients complete the Korean Barriers Questionnaire II, the Brief Pain Inventory—Korean, the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core 30, and the Korean Beck Depression Inventory. The Pain Management Index (PMI) was also assessed. Results The patients were from nine oncology clinics in university hospitals and a veterans’ hospital in South Korea. The median pain score (0–10 scale) was 4, with a median percentage of pain improvement during the last 24 h of 70 %. A total of 150 patients (75 %) received strong opioids, and 177 (88 %) achieved adequate analgesia (positive PMI). Mean scores ± SD for the Barriers Questionnaire II ranged from 1.5 ± 1 to 2.8 ± 1.1, with the harmful effects subscale the highest. In the multiple regression model, depression was significantly associated with total barrier score to pain management (p < 0.0001). Pain reduction was significantly associated with the fatalism subscale. Conclusions Depression was associated with high barrier score in patients with cancer pain. Management of cancer pain should include screening for depression, and management of depression could reduce patient-reported barriers to pain management.

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“…Although studies of analgesic adherence for cancer pain are generally lacking, existing studies have identified barriers that are multifactorial and include analgesic beliefs and concerns (Gunnarsdottir, Donovan, Serlin, Voge, & Ward, 2002; Jacobsen et al, 2010; Tzeng, Chang, Chang, & Lin, 2008), psychocognitive factors such as self-efficacy and satisfaction with pain treatment (Tzeng et al, 2008; Valeberg, Miaskowski, Hanestad, Bjordal, Moum, & Rustoen, 2008), pain and pain treatment factors (pain intensity, pain impact, pain relief, and stated need for analgesics) (Tzeng et al, 2008; Valeberg et al, 2008), and sociodemographic correlates, including age (Tzeng et al, 2008), gender, (Tzeng et al, 2008; Valeberg et al, 2008), educational level (Tzeng et al, 2008), and insurance and payment type (Bryan, De La Rosa, Hill, Amadio, & Wieder, 2008). …”

mentioning

confidence: 99%

A Pilot Study to Identify Correlates of Intentional Versus Unintentional Nonadherence to Analgesic Treatment for Cancer Pain

Meghani

Bruner

2013

Pain Management Nursing

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Existing studies of medication adherence treat “nonadherence” as a monolithic concept. The goal of this study was to isolate correlates of intentional versus unintentional nonadherence for analgesic treatment for cancer pain. Patients were recruited from outpatient oncology clinics in the middle Atlantic region, ≥18 years old, and diagnosed with solid tumors, and had an active prescription of at least one around-the-clock analgesic. The Morisky Medication Adherence Scale (MMAS) was used to assesses “unintentional” (forgetfulness/carelessness) and “intentional” (stopping use of medication if feeling better or worse) dimensions of analgesic nonadherence. A visual analog scale was used to assess the percentage of analgesic doses taken in the preceding month. A majority of participants (85.5%) took prescribed analgesics in the index period. However, 51% reported taking only up to 60% of the analgesic doses prescribed to them. Stopping taking analgesics when feeling better was the most commonly reported nonadherence behavior (74%); those reporting “intentional” nonadherence when feeling better were more likely to report not using analgesics in the index week (100% vs. 67.7%; p = .029) and agree that pain medication can keep you from knowing what is going on in your body (p = .029) and were less likely to need stronger pain medication (33.3% vs. 81.5%; p = .003). “Unintentional” nonadherence, i.e., forgetfulness/carelessness, though associated with many analgesic beliefs, was not associated with measures of analgesic use in the index period. These preliminary data indicate that different heuristics underlie intentional versus unintentional nonadherence to analgesia and that intentional and unintentional nonadherence behaviors may have different implications for pain treatment outcomes.

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Barriers to Pain Management among Lithuanian Cancer Patients

Cited by 22 publications

References 43 publications

The individual and societal burden of chronic pain in Europe: the case for strategic prioritisation and action to improve knowledge and availability of appropriate care

The individual and societal burden of chronic pain in Europe: the case for strategic prioritisation and action to improve knowledge and availability of appropriate care

Predictors of high score patient-reported barriers to controlling cancer pain: a preliminary report

A Pilot Study to Identify Correlates of Intentional Versus Unintentional Nonadherence to Analgesic Treatment for Cancer Pain

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