Advanced cancer patients able to state their own pain goals

Aug 2 2012

By Sarah Guy, MedWire Reporter

Advanced cancer patients are successfully able to express their desired level of pain relief on a scale of 1-10, indicating that personalized pain goals could be a novel target for pain treatment response, say researchers.

Personalized pain goals respect what is acknowledged to be the gold standard in assessing pain intensity; patient self-report, adds the team, and the study findings indicate that personalized pain goals are a reliable measure since they remained stable over time.

"Pain is among the most frequent, feared, and burdensome of symptoms in cancer patients and negatively impacts quality of life," explain Shalini Dalal (The University of Texas MD Anderson Center, Houston, USA) and colleagues.

They remark that the definition of a meaningful improvement in pain is lacking, but that research has shown that good communication between healthcare teams and patients, along with patient involvement in pain management, are related to greater patient satisfaction.

Therefore, the team assessed whether a personal pain goal that relies on patients' own criteria for relief would be feasible and stable over time in a group of 445 advanced cancer patients aged a mean of 59 years.

Participants scored their pain between 1 and 10, denoting the maximal intensity of pain that would be considered comfortable, with 34% reporting mild pain (score 1‑4), 21% reporting moderate pain (score 5‑6), and 37% reporting severe pain (score 7‑10) when first asked (baseline). The median score in the cohort was 3.

After a median 2-week follow-up period, the median personalized pain goal remained unchanged, report Dalal et al, "suggesting that individual patients are able to be consistent in their desired goal for pain relief."

Furthermore, the median goal score of 3 was consistent among initial pain groups (mild, moderate, and severe), suggesting that patients do not decide their personalized pain goal based on their pain intensity at a given time, they add in Cancer.

During the follow-up period, nearly half (47%) of patients achieved their personalized pain goal responses, while almost as many (41%) achieved a clinical pain response, measured using the Edmonton Symptom Assessment Scale (ESAS).

Dala and co-authors found that the sensitivity of the personalized pain goal to predict clinical (ESAS) response was highest among patients with severe baseline pain, at 98%, but that specificity was lowest in these patients, at 54%. The reverse was true in patients with mild baseline pain where the personalized pain goal had 98% specificity for clinical response, but just 52% sensitivity.

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