Prevalence and management of cancer pain in South Africa

Inadequate relief from cancer pain is an international health problem. The aim of this study was to document the prevalence and patterns of cancer pai n management in the Republic of South Africa. The first phase of this study consisted of screening 263 patients to document the prevalence of cancer p ain in varying settings. A total of 94 patients were experiencing cancer-re lated pain; this comprised 35.7% of the sample. Inpatients had a higher pre valence than outpatients, which is likely due to the fact that these patien ts are more acutely ill. Blacks (56.1%) had a higher prevalence of pain tha n whites (29.4%, P < 0.005); this difference was most pronounced in the out patient setting. Phase 2 consisted of asking 426 patients with cancer pain from different settings to complete a questionnaire that included the brief pain inventory and was designed to learn about their pain and how it was m anaged. Nearly one-third of the entire sample experienced 'worst pain' of s evere intensity. There was little difference between the public and private cancer care centers. The lowest percentage of patients with severe 'worst pain' was in the hospice setting, but even in this group about one-fourth o f the patients had peak pain that was severe. Of non-whites combined, 81% e xperienced 'worst pain' of moderate to severe intensity as compared to 65% of whites (P < 0.001). Only 21% of patients reported that they had achieved 100% pain relief. Patients experienced interference in general activity, m ood, walking, working, relations with others, sleeping, and enjoyment of li fe related to their pain. 30.5% of the entire sample had a negative score o n the pain management index, a comparison of the most potent analgesic used by a patient relative to their worst pain. Of this group, 58.1% were exper iencing severe 'worst pain'. Unrelieved cancer pain is a significant proble m. Government and non-government leaders, educators, and practitioners must collaborate to address the barriers to effective pain management and to im plement improvements in education, health policy, and health care delivery. (C) 2001 International Association for the Study of Pain. Published by Els evier Science B.V. All rights reserved.