CANCER PAIN ASSESSMENT AND MANAGEMENT BY HOUSESTAFF

Pain control for cancer patients is a significant problem in health ca re, and lack of expertise by clinicians in assessing and managing canc er pain is an important cause of inadequate pain management. This stud y was designed to use performance-based testing to evaluate the skills of resident physicians in assessing and managing the severe chronic p ain of a cancer patient. Thirty-three resident physicians (PGY 1-6) we re presented with the same standardized severe cancer pain patient and asked to complete a detailed pain assessment. The residents then comp leted questions related to management of the cancer pain patient. In t he cancer pain assessment, residents did well in assessing pain onset (70%), temporal pattern of pain (64%), and pain location (73%). Howeve r, only 33% and 45% physicians adequately assessed the pain descriptio n and pain intensity, respectively, and assessment of pain-relieving f actors, previous pain history, and psychosocial history was done poorl y or not at all by 70%, 88%, and 94% of residents. Only 58% of the res idents were judged to be competent in this clinical cancer pain assess ment. In the cancer pain management section, opioid analgesic therapy was prescribed by 98% of residents, and 91% used the oral route. Howev er, only 18% of prescriptions were for regular use and 88% of resident s did not provide analgesics for breakthrough pain. A significant numb er of graduated physicians were judged to be not competent in the asse ssment and management of the severe pain of a standardized cancer pati ent. Opioids and NSAIDs were the analgesics of choice; however, most w ere prescribed on a PRN basis only. Co-analgesics were rarely prescrib ed. Few physicians managed persistent, severe cancer pain according to the WHO guideline of increasing the opioid dose. The lack of signific ant difference in scores between junior and senior residents suggest t hat adequate cancer pain management is not being effectively taught in postgraduate training programs.