Oncologic pain
An irresolute problem. Survey to resident physicians in the Hospital Maciel
Keywords:
PAIN, OPIOID ANALGESICS, MORPHINE, NEOPLASMS
Abstract
Background. Pain, a symptom of high prevalence in patients with cancer, strongly undermines quality of life. Pain could be controlled in most of the cases following the World Health Organization (WHO) guidelines (1986) that included the use of morphine. This health problem relies on health workers (lack of medical education, inaccurate beliefs), health structure, patients and their families.
Objective. To assess surgeons knowledge regarding WHO guidelines, especially those related to use of morphine to manage pain.
Methods. A transversal and descriptive study by means of a survey was done in the Hospital Maciel.
Results. 75% of the surveyed physicians do not know the WHO guidelines; 67% do not prescribe regularly morphine; 63% do not know that morphine has no maximum doses; 41% prescribe analgesic at request; 75% ignore the administration intervals of the drug. Secondary effects most indicated are those unfrequent. 43% of surveyed physicians have not read any paper during the last three years and 29% have read only one.
Conclusions. Resident physicians are unaware of WHO analgesic guidelines and the use of morphine. Possible solutions to deal this problem are indicated.
References
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3) Bonica JJ. Cancer pain. In: Bonica JJ. The management of pain. 2ª ed. Philadelphia: Lea and Phebiger, 1990: 400-1.
4) Bonica JJ. Treatment of pain: current status and future needs. In: Fields HL. Advances in pain research and therapy. New York: Raven Press, 1985: 589-616.
5) Trelis I, Navarro J. Dolor difícil en Cuidados Paliativos. Med Paliat 2001; 8(1): 53-4.
6) Manfredi PL, Chandler S, Pigazzi A, Payne R. Outcome of cancer pain consultations. Cancer 2000; 89(4): 920-4.
7) Schug SA, Zech D, Dorr U. Cancer pain management according to WHO analgesic guidelines. J Pain Symptom Manage 1990; 5(1): 27-32.
8) Teoh N, Stjernsward J. WHO cancer pain relief program, ten years on. Seattle: International Association for the Study of Pain, IASP Newsletter, 1992: 5-6.
9) Nacional Cancer Institute. NCI Workshop on cancer pain. 1990.
10) Organización Mundial de la Salud. Alivio del dolor en el cáncer. Ginebra: OMS, 1996.
11) World Health Organization. Cancer pain relief. Geneva: WHO, 1986.
12) Gómez Sancho M. Bases para el control de síntomas y el uso de fármacos. In: Gómez Sancho M. Avances en Cuidados paliativos. Las Palmas de Gran Canarias: Gabinete de Asesoramiento y Formación Sociosanitaria, 2003: 3-18.
13) Von Roenn JH, Cleeland CS, Gonin R, Hatfield AK, Pandya KJ. Physician attitudes and practice in cancer pain management: a survey from the Eastern Cooperative Oncology Group. Ann Intern Med 1993; 119(2): 121-6.
14) Levin DN, Cleeland CS, Dar R. Public attitudes toward cancer pain. Cancer 1985; 56(9): 2337-9.
15) Ward SE, Goldberg N, Miller-Mccauley V, Mueller C, Nolan A. Patient-related barriers to management of cancer pain. Pain 1993; 52(3): 319-24.
16) Cleeland CS. Barriers to the management of cancer pain. Oncology (Huntingt) 1987; 1(2 Suppl): 19-26.
17) Joranson DE. Are health care reimbursement policies a barrier to cute and cancer pain management? J Pain Symptom Manage 1994; 9(4): 244-53
18) Hill CS Jr. The barriers to adequate pain management with opioid analgesics. Semin Oncol 1993; 20(2 Suppl 1): 1-5.
19) Grossman SA, Sheidler VR, Swedeen K, Mucenski J, Piantadosi S. Correlation of patient and caregiver ratings of cancer pain. J Pain Symptom Manage 1991; 6(2): 53-7.
20) Cleeland CS, Cleeland LM, Dar R, Rinehardt LC. Factors influencing physician management of cancer pain. Cancer 1986; 58(3): 796-800.
21) Ferrel BR, Cronin Nash C, Warfield C. The role of patient-controlled analgesia in the management of cancer pain. J Pain Symptom Manage 1992; 7(3): 149-54.
22) Shapiro RS. Liability issues in the management of pain. J Pain Symptom Manage 1994; 9(3): 146-52.
23) Marks RM, Sachar EJ. Undertreatment of medical inpatients with narcotics analgesics. Ann Intern Med 1973; 78(2): 173-81.
24) Breitbart W, Payne DK. Pain. In: Holland J. Psichooncolo-gy. New York: Oxford University Press, 1998: 450-67.
25) Saunders C. The symptomatic treatment of incurable malignant disease. Prescr J 1964; 4: 68-73.
26) Max MB. Improving outcomes of analgesic treatment: is education enough? Ann Intern Med 1990; 113(11): 885-9.
27) Comisión Honoraria de Lucha contra el Cáncer. Encuesta nacional a médicos generales sobre conocimientos, creencias, actitudes y prácticas sobre cáncer. Montevideo: CHLCC, 1993.
28) Píriz G, Ramos L, Cardozo A, Buccino AC, Goldner C, Carrasco A, et al. Desempeño profesional y personal, a juicio del encuestado, en una muestra de médicos no oncólogos que asisten pacientes con cáncer. In: Libro de Publicaciones del Congreso. Congreso Nacional de Medicina Interna, 29. Montevideo, 2000: 276-80.
29) Cesarco R, Goldner C, Petit I, Píriz G, Puig M, Ramos L, et al. Unidad de Medicina Paliativa Hospital Maciel. Cuad Med Inter 2002: 39-43.
30) Grond S, Zech D, Diefenback CH, Radbruch L, Lehmann KA. Assessment of cancer pain: a prospective evaluation in 2266 cancer pain patients referred to a pain service. Pain 1996; 64(1): 107-14.
31) Gómez Sancho M. Historia del opio. Mitos y realidades de la morfina. In: Gómez Sancho M. Avances en Cuidados Paliativos. Las Palmas de Gran Canarias: Gabinete de Asesoramiento y Formación Sociosanitaria, 2003: 355-70.
32) Gómez Sancho M, Reig E. Uso de la Morfina. Madrid: Fernández Ciudad, 1997: 75-96.
33) Cherny N, Ripamonti C, Pereira J, Fallon M, Mcquay H, Mercadante S, et al. Strategies to manage the adverse effects of oral morphine: an evidence-based report. J Clin Oncol 2001; 19(9): 2542-4.
34) Hanks G, Cherny N. Opioids analgesic therapy. In: Doyle D, Hanks G, Mcdonald N. Oxford Textbook of Palliative Medicine. 2ª ed. New York: Oxford University Press, 1998: 331-54.
35) Papa M, Khon WE, Ayala W. Tratamiento del dolor oncológico con morfina oral y subcutánea. Congreso Sudamericano de Anestesiología, 4. Congreso Uruguayo de Anestesiología, 11. Montevideo, 1996. Anest Analg Rean (Montevideo-SAU), 1999; 15(1): 11-8.
36) Reisine T, Pasternak G. Analgésicos opioides y sus antagonistas. In: Hardman JG, Limbird LE, Molinoff PB, Ruddon RW. Goodman and Gilman Las bases farmacológicas de la terapéutica. 9 ed. México: McGraw-Hill, Interamericana, 1996: 557-93.
37) Porter J, Jick H. Addiction rare in patients treated with narcotics. N Engl J Med 1980; 302(2): 123.
38) Pascual A, Berro MJ, Ferrer A, Gisbert A, Gómez Sancho M, Herrera J, et al. Prevalencia de dolor en hospitales. Grupo de trabajo "Hospital sin Dolor". Libro de Ponencias del III Congreso de Sociedad Española de Cuidados Paliativos. Valencia 3-5 de mayo de 2000. Santander: SECPAL, 1998: 411.
39) Almagro E, Lebreros R, Sequier L, Fernández MA, Rosillo F, Duque A, et al. Encuesta a los MIR de un hospital general sobre el uso y conocimiento de la morfina. http://www.secpal.com/revista/resumen_posters/resumen_posters_115.htm[Consulta: 14/07/03].
40) Cleeland C. Research in cancer pain. What we know and what need to know. Cancer 1991; 67(3 Suppl): 823-7.
41) Mortimer JE, Bartlett NL. Assessment of knowledge about cancer pain management by physicians in training. J Pain Symptom Manage 1997; 14(1): 21-8.
42) The Support Principal Investigators. A controlled trial to improve care for seriously ill hospitalized patients: The Study to understand prognoses and preferences for outcomes and risks of treatments (SUPPORT). JAMA 1995; 274(20): 1591-8. Erratum in: JAMA 1996; 275(16): 1232.
43) Weinstein SM, Laux LF, Thornby JI, Lorimor RJ, Hill CS Jr, Thorpe DM, et al. Physicians' attitudes toward pain and the use of opioid analgesics: results of a survey from the Texas Cancer Pain Initiative. South Med J 2000; 93(5): 479-87.
44) Wells M, Dryden H, Guild P, Levack P, Farrer K, Mowat P. The knowledge and attitudes of surgical staff towards the use of opioids in cancer pain management: can the Hospital Palliative care Team make a difference? Eur J Cancer Care 2001; 10(3): 201-11.
45) Larue F, Colleau SM, Brasseur L, Cleeland CS. Multicentre study of cancer pain and its treatment in France. BMJ 1995; 310(6986): 1034-7.
46) Larue F, Colleau SM, Fontaine A, Brasseur L. Oncologists and primary care physicians' attitudes toward pain control and morphine prescribing in France. Cancer 1995; 76(11): 2375-82.
47) Stiefel F, Morant R, Radziwill A, Senn HJ. Attitudes of Swiss physicians in prescribing opiates for cancer pain. Support Care Cancer 1993; 1(5): 259-62.
48) Minotti V, Betti M. Attitudes of Italian general practitioners in the treatment of cancer pain. The Committee of the Associazione Italiana di Oncologia Medica (AIOM). Tumori 1997; 83(4): 729-31.
49) Macdonald N, Ayoub J, Farley J, Foucault C, Lesage P, Mayo N. A Quebec survey of issues in cancer pain management. J Pain Symptom Manage 2002; 23(1): 39-47.
50) Sapir R, Catane R, Strauss-Liviatan N, Cherny NI. Cancer pain: knowledge and attitudes of physicians in Israel. J Pain Symptom Manage 1999; 17(4): 266-76.
51) Mohanti BK, Bansal M, Gairola M, Sharma D. Palliative care education and training during residency: a survey among residents at a tertiary care hospital. Natl Med J India 2001; 14(4): 224.
52) Federación Europea de Delegaciones de la Asociación Internacional para el Estudio del Dolor. Report of the Standard and education task group. Rev Soc Esp Dolor 1999; 6: 132-46.
53) Ojeda Martín M. Análisis clínico epidemiológico del tratamiento del dolor en enfermos terminales ingresados en una Unidad de Medicina Paliativa: experiencia de 7 años. Las Palmas de Gran Canarias: Acta Médica, 2001: 18-26.
54) Devulder J. Persisting misconceptions of Belgian physicians and nurses about cancer pain treatment. Act Clin Belg 1999; 54(6): 346-50.
55) Sanz-Rubiales A, Del Valle ML, González C, Hernansanz S, García C, Sánchez T, et al. Formación en el uso de opioides: ¿Repercute en la práctica diaria? Rev Soc Esp Dolor 2001; 8: 461-7.
2) Gómez Sancho M. Historia clínica del dolor: clasificación, evaluación y prevalencia. In: Gómez Sancho M. Avances en Cuidados Paliativos. Las Palmas de Gran Canarias: Gabinete de Asesoramiento y Formación Sociosanitaria, 2003: 223-50.
3) Bonica JJ. Cancer pain. In: Bonica JJ. The management of pain. 2ª ed. Philadelphia: Lea and Phebiger, 1990: 400-1.
4) Bonica JJ. Treatment of pain: current status and future needs. In: Fields HL. Advances in pain research and therapy. New York: Raven Press, 1985: 589-616.
5) Trelis I, Navarro J. Dolor difícil en Cuidados Paliativos. Med Paliat 2001; 8(1): 53-4.
6) Manfredi PL, Chandler S, Pigazzi A, Payne R. Outcome of cancer pain consultations. Cancer 2000; 89(4): 920-4.
7) Schug SA, Zech D, Dorr U. Cancer pain management according to WHO analgesic guidelines. J Pain Symptom Manage 1990; 5(1): 27-32.
8) Teoh N, Stjernsward J. WHO cancer pain relief program, ten years on. Seattle: International Association for the Study of Pain, IASP Newsletter, 1992: 5-6.
9) Nacional Cancer Institute. NCI Workshop on cancer pain. 1990.
10) Organización Mundial de la Salud. Alivio del dolor en el cáncer. Ginebra: OMS, 1996.
11) World Health Organization. Cancer pain relief. Geneva: WHO, 1986.
12) Gómez Sancho M. Bases para el control de síntomas y el uso de fármacos. In: Gómez Sancho M. Avances en Cuidados paliativos. Las Palmas de Gran Canarias: Gabinete de Asesoramiento y Formación Sociosanitaria, 2003: 3-18.
13) Von Roenn JH, Cleeland CS, Gonin R, Hatfield AK, Pandya KJ. Physician attitudes and practice in cancer pain management: a survey from the Eastern Cooperative Oncology Group. Ann Intern Med 1993; 119(2): 121-6.
14) Levin DN, Cleeland CS, Dar R. Public attitudes toward cancer pain. Cancer 1985; 56(9): 2337-9.
15) Ward SE, Goldberg N, Miller-Mccauley V, Mueller C, Nolan A. Patient-related barriers to management of cancer pain. Pain 1993; 52(3): 319-24.
16) Cleeland CS. Barriers to the management of cancer pain. Oncology (Huntingt) 1987; 1(2 Suppl): 19-26.
17) Joranson DE. Are health care reimbursement policies a barrier to cute and cancer pain management? J Pain Symptom Manage 1994; 9(4): 244-53
18) Hill CS Jr. The barriers to adequate pain management with opioid analgesics. Semin Oncol 1993; 20(2 Suppl 1): 1-5.
19) Grossman SA, Sheidler VR, Swedeen K, Mucenski J, Piantadosi S. Correlation of patient and caregiver ratings of cancer pain. J Pain Symptom Manage 1991; 6(2): 53-7.
20) Cleeland CS, Cleeland LM, Dar R, Rinehardt LC. Factors influencing physician management of cancer pain. Cancer 1986; 58(3): 796-800.
21) Ferrel BR, Cronin Nash C, Warfield C. The role of patient-controlled analgesia in the management of cancer pain. J Pain Symptom Manage 1992; 7(3): 149-54.
22) Shapiro RS. Liability issues in the management of pain. J Pain Symptom Manage 1994; 9(3): 146-52.
23) Marks RM, Sachar EJ. Undertreatment of medical inpatients with narcotics analgesics. Ann Intern Med 1973; 78(2): 173-81.
24) Breitbart W, Payne DK. Pain. In: Holland J. Psichooncolo-gy. New York: Oxford University Press, 1998: 450-67.
25) Saunders C. The symptomatic treatment of incurable malignant disease. Prescr J 1964; 4: 68-73.
26) Max MB. Improving outcomes of analgesic treatment: is education enough? Ann Intern Med 1990; 113(11): 885-9.
27) Comisión Honoraria de Lucha contra el Cáncer. Encuesta nacional a médicos generales sobre conocimientos, creencias, actitudes y prácticas sobre cáncer. Montevideo: CHLCC, 1993.
28) Píriz G, Ramos L, Cardozo A, Buccino AC, Goldner C, Carrasco A, et al. Desempeño profesional y personal, a juicio del encuestado, en una muestra de médicos no oncólogos que asisten pacientes con cáncer. In: Libro de Publicaciones del Congreso. Congreso Nacional de Medicina Interna, 29. Montevideo, 2000: 276-80.
29) Cesarco R, Goldner C, Petit I, Píriz G, Puig M, Ramos L, et al. Unidad de Medicina Paliativa Hospital Maciel. Cuad Med Inter 2002: 39-43.
30) Grond S, Zech D, Diefenback CH, Radbruch L, Lehmann KA. Assessment of cancer pain: a prospective evaluation in 2266 cancer pain patients referred to a pain service. Pain 1996; 64(1): 107-14.
31) Gómez Sancho M. Historia del opio. Mitos y realidades de la morfina. In: Gómez Sancho M. Avances en Cuidados Paliativos. Las Palmas de Gran Canarias: Gabinete de Asesoramiento y Formación Sociosanitaria, 2003: 355-70.
32) Gómez Sancho M, Reig E. Uso de la Morfina. Madrid: Fernández Ciudad, 1997: 75-96.
33) Cherny N, Ripamonti C, Pereira J, Fallon M, Mcquay H, Mercadante S, et al. Strategies to manage the adverse effects of oral morphine: an evidence-based report. J Clin Oncol 2001; 19(9): 2542-4.
34) Hanks G, Cherny N. Opioids analgesic therapy. In: Doyle D, Hanks G, Mcdonald N. Oxford Textbook of Palliative Medicine. 2ª ed. New York: Oxford University Press, 1998: 331-54.
35) Papa M, Khon WE, Ayala W. Tratamiento del dolor oncológico con morfina oral y subcutánea. Congreso Sudamericano de Anestesiología, 4. Congreso Uruguayo de Anestesiología, 11. Montevideo, 1996. Anest Analg Rean (Montevideo-SAU), 1999; 15(1): 11-8.
36) Reisine T, Pasternak G. Analgésicos opioides y sus antagonistas. In: Hardman JG, Limbird LE, Molinoff PB, Ruddon RW. Goodman and Gilman Las bases farmacológicas de la terapéutica. 9 ed. México: McGraw-Hill, Interamericana, 1996: 557-93.
37) Porter J, Jick H. Addiction rare in patients treated with narcotics. N Engl J Med 1980; 302(2): 123.
38) Pascual A, Berro MJ, Ferrer A, Gisbert A, Gómez Sancho M, Herrera J, et al. Prevalencia de dolor en hospitales. Grupo de trabajo "Hospital sin Dolor". Libro de Ponencias del III Congreso de Sociedad Española de Cuidados Paliativos. Valencia 3-5 de mayo de 2000. Santander: SECPAL, 1998: 411.
39) Almagro E, Lebreros R, Sequier L, Fernández MA, Rosillo F, Duque A, et al. Encuesta a los MIR de un hospital general sobre el uso y conocimiento de la morfina. http://www.secpal.com/revista/resumen_posters/resumen_posters_115.htm[Consulta: 14/07/03].
40) Cleeland C. Research in cancer pain. What we know and what need to know. Cancer 1991; 67(3 Suppl): 823-7.
41) Mortimer JE, Bartlett NL. Assessment of knowledge about cancer pain management by physicians in training. J Pain Symptom Manage 1997; 14(1): 21-8.
42) The Support Principal Investigators. A controlled trial to improve care for seriously ill hospitalized patients: The Study to understand prognoses and preferences for outcomes and risks of treatments (SUPPORT). JAMA 1995; 274(20): 1591-8. Erratum in: JAMA 1996; 275(16): 1232.
43) Weinstein SM, Laux LF, Thornby JI, Lorimor RJ, Hill CS Jr, Thorpe DM, et al. Physicians' attitudes toward pain and the use of opioid analgesics: results of a survey from the Texas Cancer Pain Initiative. South Med J 2000; 93(5): 479-87.
44) Wells M, Dryden H, Guild P, Levack P, Farrer K, Mowat P. The knowledge and attitudes of surgical staff towards the use of opioids in cancer pain management: can the Hospital Palliative care Team make a difference? Eur J Cancer Care 2001; 10(3): 201-11.
45) Larue F, Colleau SM, Brasseur L, Cleeland CS. Multicentre study of cancer pain and its treatment in France. BMJ 1995; 310(6986): 1034-7.
46) Larue F, Colleau SM, Fontaine A, Brasseur L. Oncologists and primary care physicians' attitudes toward pain control and morphine prescribing in France. Cancer 1995; 76(11): 2375-82.
47) Stiefel F, Morant R, Radziwill A, Senn HJ. Attitudes of Swiss physicians in prescribing opiates for cancer pain. Support Care Cancer 1993; 1(5): 259-62.
48) Minotti V, Betti M. Attitudes of Italian general practitioners in the treatment of cancer pain. The Committee of the Associazione Italiana di Oncologia Medica (AIOM). Tumori 1997; 83(4): 729-31.
49) Macdonald N, Ayoub J, Farley J, Foucault C, Lesage P, Mayo N. A Quebec survey of issues in cancer pain management. J Pain Symptom Manage 2002; 23(1): 39-47.
50) Sapir R, Catane R, Strauss-Liviatan N, Cherny NI. Cancer pain: knowledge and attitudes of physicians in Israel. J Pain Symptom Manage 1999; 17(4): 266-76.
51) Mohanti BK, Bansal M, Gairola M, Sharma D. Palliative care education and training during residency: a survey among residents at a tertiary care hospital. Natl Med J India 2001; 14(4): 224.
52) Federación Europea de Delegaciones de la Asociación Internacional para el Estudio del Dolor. Report of the Standard and education task group. Rev Soc Esp Dolor 1999; 6: 132-46.
53) Ojeda Martín M. Análisis clínico epidemiológico del tratamiento del dolor en enfermos terminales ingresados en una Unidad de Medicina Paliativa: experiencia de 7 años. Las Palmas de Gran Canarias: Acta Médica, 2001: 18-26.
54) Devulder J. Persisting misconceptions of Belgian physicians and nurses about cancer pain treatment. Act Clin Belg 1999; 54(6): 346-50.
55) Sanz-Rubiales A, Del Valle ML, González C, Hernansanz S, García C, Sánchez T, et al. Formación en el uso de opioides: ¿Repercute en la práctica diaria? Rev Soc Esp Dolor 2001; 8: 461-7.
Published
2004-03-31
How to Cite
1.
Píriz Álvarez G, Estragó V, Pattarino C, Sandar T. Oncologic pain. Rev. Méd. Urug. [Internet]. 2004Mar.31 [cited 2024Nov.17];20(1):32-3. Available from: http://www2.rmu.org.uy/ojsrmu311/index.php/rmu/article/view/929
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