Improving the quality of pain treatment by a tailored pain education programme for cancer patients in chronic pain

Educational interventions, aiming to increase patients' knowledge and attit ude regarding pain, can affect pain treatment. The purpose of this study wa s to evaluate the effects of a Pain Education Programme (PEP), on adequacy of pain treatment, and to describe characteristics predicting change in ade quacy. The PEP consists of a multi-method approach in which patients are ed ucated about the basic principles regarding pain, instructed how to report pain in a pain diary, how to communicate about pain, and how to contact hea lthcare providers. The effects of the PEP were evaluated taking into consid eration the lack of well-established outcome measures to evaluate adequacy of pain treatment, the lack of long-term follow-up, and the influence of mi ssing data. A prospective, randomized study was utilized in which 313 chronic cancer pa tients were followed-up until 8 weeks postdischarge. Adequacy of pain treat ment was evaluated by means of the Amsterdam Pain Management Index (APMI), consisting of an integrated score of patients' Present Pain Intensity, Aver age Pain Intensity, and Worst Pain Intensity, corrected for patients' Toler able Present Pain, with the analgesics used by the patient. At pretest, 60% of the patients in the hospital were treated inadequately f or their pain. Postdischarge, the control group patients were significantly more inadequately treated at 2 weeks after discharge (56% vs 41%), at 4 we eks after discharge (62% vs 42%) and at 8 weeks after discharge (57% vs 51% ) than the intervention group patients. While the level of inadequacy in th e control groups remained relatively stable at all assessment points, a sli ght increase in the percentage of patients being treated inadequately was f ound in the intervention group patients over time. A beneficial effect of t he PEP was found for patients both with and without district nursing. Varia bles predicting an improvement in adequacy of pain treatment consisted of t he PEP, the APMI score at baseline, patients' level of physical functioning , patients' level of social functioning, the extent of adherence to pain me dication, patients' pain knowledge, and the amount of analgesics used. These findings suggest that quality of pain treatment in cancer patients wi th chronic pain can be enhanced by educating patients about pain and improv ing active participation in their own pain treatment. The benefit from the PEP, however, decreases slightly over time, pointing at a need for ongoing education. (C) 2001 European Federation of Chapters of the International As sociation for the Study of Pain.