Negative pain management index scores do not necessarily indicate inadequate pain management: a cross-sectional study

Sakakibara, Naoki; Higashi, Takahiro; Yamashita, Itsuku; Yoshimoto, Tetsusuke; Matoba, Motohiro

doi:10.1186/s12904-018-0355-8

Cited by 17 publications

(20 citation statements)

References 15 publications

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“…However, caution must be exercised when interpreting the results of pain management index. Previous studies have already identified that though pain intensity is expected to decrease as the PMI score increases this is not always true [31]. For example, in this study, only 2.5% of patients were inadequately treated at 24 hours, despite the fact that about 40% needed more analgesics than prescribed at this particular time.…”

Section: Discussionmentioning

confidence: 55%

“…Secondly, Sakakibara, N., et al, have identified that those with –1 score (therefore bad pain control, according to PMI), have scored more pain interference than those with PMI score 0 (good pain control). The authors recommended that when the aim is to identify definitively inadequate care, PMI scores of − 2 and − 3 should be considered, and not scores of − 1 [31]. In addition in spite of receiving strong opioids, previous reports have shown that approximately 85% of patients reported uncontrolled postoperative pain [32, 34].…”

Section: Discussionmentioning

confidence: 99%

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Quality of postoperative pain management in Ethiopia: A prospective longitudinal study

Eshete

Baeumler

Siebeck³

et al. 2019

PLoS ONE

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Background The annual number of surgical operations performed is increasing throughout the world. With this rise in the number of surgeries performed, so too, the challenge of effectively managing postoperative pain. In Africa, there are scanty data available that make use of multi-center data to characterize the quality of postoperative pain management. In this study using a longitudinal data, we have attempted to characterize the quality of postoperative pain management; among patients scheduled for major elective orthopedic, gynecologic and general surgery. Methods This prospective longitudinal study evaluated the quality of postoperative pain management in patients undergoing elective general, gynecologic, and orthopedic surgery. We quantified the prevalence of moderate to severe postoperative pain with the International Pain Outcome Questionnaire and the corresponding adequacy of treatment with the pain management index. At four time points after surgery, we estimated pain severity, its physical and emotional interference, and patient satisfaction. Results Moderate to severe postoperative pain was present in 88.2% of patients, and pain was inadequately treated in 58.4% of these patients. Chronic pain (β = 0.346, 95% CI: 0.212, 0.480) predicted patients’ worst pain intensity. Gender was not associated with the worst pain intensity or percentage of time spent in severe pain. Patient’s pain intensity did not predicted the level of satisfaction. Conclusions The prevalence of moderate to severe postoperative pain and its functional interference is high in Ethiopian patients. The treatment provided to patients is inadequate and not in line with international recommendations and standards.

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Section: Discussionmentioning

confidence: 55%

Section: Discussionmentioning

confidence: 99%

Quality of postoperative pain management in Ethiopia: A prospective longitudinal study

Eshete

Baeumler

Siebeck³

et al. 2019

PLoS ONE

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“…Cancer-related pain (CRP) can be nociceptive pain which comes from the actual damage of nonneural tissues and neuropathic pain which is caused by damage of the somatosensory nervous system [ 3 , 6 , 8 ]. Pain assessment is an integral component of cancer pain management which aims at identifying pain characteristics, pain etiology, specific pain syndromes, and analgesic targets using pain management index (PMI) [ 9 ]. To manage CRP effectively, the WHO has developed a 3-step pain ladder which includes the use of a nonopioid (paracetamol) for mild pain, a weak opioid (Codeine) for moderate pain, and a strong opioid (morphine) for severe pain [ 10 ].…”

Section: Introductionmentioning

confidence: 99%

Adequacy of Cancer-Related Pain Treatments and Factors Affecting Proper Management in Ayder Comprehensive Specialized Hospital, Mekelle, Ethiopia

Tuem

Gebremeskel

Hiluf

et al. 2020

Journal of Oncology

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Background. Cancer-related pain (CRP) is a major problem with a potential negative impact on quality of life of the patients and their caregivers. Purpose. To assess the adequacy of cancer-related pain management in Ayder Comprehensive Specialized Hospital (ACSH). Methodology. A facility-based cross-sectional study design was conducted in ACSH from January to March 2019. A well-structured professional-assisted questionnaire using Brief Pain Inventory-Short Form (BPI-SF) was used to collect data concerning the severity of pain, functioning interference, and adequacy of pain management in cancer patients. Data were analyzed using SPSS v.21. Result. Out of 91 participants, 47 (51.6%) were male and 52 (57.1%) were between the age group of 18–45, with the mean age of 44.8 ± 13.6 years. According to the pain assessment tool (BPI), 85 (93.4%) patients experienced pain and 90 (98.9%) patients had activity interference; negative pain management index (PMI) was observed in 40 (43.95%) patients, showing that 43.95% were receiving inadequate pain management. Out of 38 patients who received no analgesics, 35.2% were found to have inadequate pain management, whereas those who took strong opioids had 100% effective pain management and the majority of the patients were in stage III. Among 38 (41.76%) only 20 (52.63%) received adequate pain management, based on patients’ self-report in which 18.7% of the participants stated that they got 30% pain relief and only 1.1% got 90% relief. The predictors of undertreatment were presence of severe pain, metastasis, comorbidity, and stage of the cancer and could also be due to the educational level and monthly income, as evidenced by significant association. Conclusion. This study suggests that cancer pain management in ACSH was sufficient for only 56%. However, large numbers of individuals are suffering from a manageable pain. Hence, remedial action should be taken, including increasing awareness of symptom management in medical staff and incorporating existing knowledge into routine clinical practice.

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“…Furthermore, the sensitivity of PMI scores of < −1 and < 0 for predicting pain interference were only 0.16 and 0.37, and the corresponding specificities were 0.95 and 0.71, respectively. This implies that a negative PMI does not always indicate inadequate pain management [20].…”

Section: Pain Prevalence: Reasons For Lack Of Improvement In Cancementioning

confidence: 99%

Treatment of Pain in Cancer: Towards Personalised Medicine

Everdingen

Kuijk

Janssen

et al. 2018

Cancers

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Despite increased attention to cancer pain, pain prevalence in patients with cancer has not improved over the last decade and one third of cancer patients on anticancer therapy and half of patients with advanced disease still suffer from moderate to severe pain. In this review, we explore the possible reasons for the ongoing high prevalence of cancer pain and discuss possible future directions for improvement in personalised pain management. Among possible reasons for the lack of improvement are: Barriers for patients to discuss pain with clinicians spontaneously; pain measurement instruments are not routinely used in daily practice; limited knowledge concerning the assessment of undertreatment; changes in patients’ characteristics, including the ageing of the population; lack of significant improvement in the treatment of neuropathic pain; limitations of pharmacological treatment and lack of evidence-based nonpharmacological treatment strategies. In order to improve cancer pain treatment, we recommend: (1) Physicians proactively ask about pain and measure pain using assessment instruments; (2) the development of an optimal tool measuring undertreatment; (3) educational interventions to improve health care workers’ skills in pain management; (4) the development of more effective and personalised pharmacological and nonpharmacological pain treatment.

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Negative pain management index scores do not necessarily indicate inadequate pain management: a cross-sectional study

Cited by 17 publications

References 15 publications

Quality of postoperative pain management in Ethiopia: A prospective longitudinal study

Quality of postoperative pain management in Ethiopia: A prospective longitudinal study

Adequacy of Cancer-Related Pain Treatments and Factors Affecting Proper Management in Ayder Comprehensive Specialized Hospital, Mekelle, Ethiopia

Treatment of Pain in Cancer: Towards Personalised Medicine

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