Skip to main content

Advertisement

Log in

Facilitating cancer pain control in the home: Opioid-related issues

  • Published:
Current Pain and Headache Reports Aims and scope Submit manuscript

Abstract

The basic principles of pain management are the same whether the patient is in an acute care setting, their home, or a long-term care facility. Wherever the setting, pain management is part of the comprehensive care for the cancer patient. Successful therapy depends on a clear definition of treatment goals, an informed patient and family, collaboration and effective communication between the physician, home care nurse, patient and family, and ongoing monitoring to ensure effectiveness of pain relief measures. Careful discharge planning to ensure appropriate home care for the patient with pain and their family is critical.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

References and Recommended Reading

  1. Bonica JJ, Ventafridda V, Twycross RG: Cancer pain. In The Management of Pain, edn 2. Edited by Bonica JJ. Lea & Feberger; 1990:400-460.

  2. McNally JC: Home care for oncology patients. Semin Oncol Nurs 1996, 12:177–178.

    Article  Google Scholar 

  3. Seeber S, Baird SB: The impact of health care changes in home health. Semin Oncol Nurs 1996, 12:179–187.

    Article  PubMed  CAS  Google Scholar 

  4. Magrum LC, Bentzen C, Landmark S: Pain management in home care. Semin Oncol Nurs 1996, 12:202–218.

    Article  PubMed  CAS  Google Scholar 

  5. Juarez E, Ferrell BR: Family and caregivers involvement in pain management. Clin of Geriatr Med 1996, 12:531–547.

    CAS  Google Scholar 

  6. Fishman B: The treatment of suffering in patients with cancer pain: cognitive behavioral approaches. In 2nd International Congress in Cancer Pain: Advances in Pain Research and Therapy, vol 16. Edited by Foley KM et al. New York: Raven Press; 1990:301–316.

    Google Scholar 

  7. Lazarus RS, Folkman C: Stress, Appraisal and Coping. New York: Springer; 1984.

    Google Scholar 

  8. Syrjala KL: Integrating medical and psychological treatments for cancer pain. In Current and Emerging Issues in Cancer Pain: Research and Practice. Edited by Chapman CR, Foley KM. New York: Raven Press; 1993:309–409.

    Google Scholar 

  9. Bolund C: Medical and care factors in suicide in cancer patients in Sweden. J Psychooncology 1985, 3:31–52.

    Google Scholar 

  10. Breitbart W: Suicide in the cancer patient. Oncology 1987, 1:49–54.

    PubMed  CAS  Google Scholar 

  11. Cleeland CS: The impact of pain on the patient with cancer. Cancer 1984, 54:2635–2641.

    Article  PubMed  CAS  Google Scholar 

  12. Baile WF, Di Maggio JR, Schapiro DV, et al.: The request for assistance in dying: the need for psychiatric consultation. Cancer 1993, 72:2786–2791.

    Article  PubMed  CAS  Google Scholar 

  13. Breitbart W: Cancer pain and suicide. In 2nd International Congress on Cancer Pain: Advances in Pain Research and Therapy, vol 16. Edited by Foley KM et al. New York: Raven Press; 1990:399–412.

    Google Scholar 

  14. World Health Organization: Cancer Pain Relief and Palliative Care. Geneva: WHO; 1990.

    Google Scholar 

  15. Joint Commission on Accreditation of Health Care Organization: Comprehensive accreditation manual for ambulatory care (section R1.27 to P1.3.1) (1999). Available at: www.jcaho.org/standard/pm_ac.htlm. In 1997, the Wisconsin Pain Initiative received a 3-year grant from the Robert Wood Johnson Foundation to make pain assessment and management an integral part of the nation’s health care system. Their work with the JCAHO, a group that accredits 80% of the nation’s hospitals and 98% of licensed beds, resulted in the development of these new standards. Compliance to these standards is expected by the year 2001.

  16. Jacox A, Carr DB, Payne R: Management of Cancer Pain: Clinical Practice Guidelines No. 9. AHCPR publication No 94-0592. Rockville, MD: Agency for Health Care Policy and Research. U.S. Department for Health and Human Services. Public Health Services, March 1994.

  17. Ward SE, Goldberg N, Miller-McCauley V, et al.: Patient related barriers to management of cancer pain. Pain 1993, 52:319–324.

    Article  PubMed  CAS  Google Scholar 

  18. Grossman SA, Shiedler VR, Swedeen K, et al.: Correlations of patient and caregiver ratings of cancer pain. J Pain Symptom Manage 1991, 6:53–57.

    Article  PubMed  CAS  Google Scholar 

  19. Taylor EJ, Ferrell BR, Grant M, et al.: Managing cancer pain at home: the decisions and ethical conflicts of patients, family caregivers and home care nurses. Oncol Nurs Forum 1993, 20:919–927.

    PubMed  CAS  Google Scholar 

  20. Miaskowski C, Zimmer EF, Barrett, KM, et al.: Differences in patients’ and family caregivers perceptions of the pain experience influence patient and family caregiver outcomes. Pain 1997, 72:217–226.

    Article  PubMed  CAS  Google Scholar 

  21. Yeager KA, Miaskowski C, Dibble SL, et al.: Differences in pain knowledge and perception of the pain experience between outpatients with cancer and their family caregivers. Oncol Nurs Forum 1995, 22:1235–1241.

    PubMed  CAS  Google Scholar 

  22. Ferrell BR: The family. In Oxford Textbook of Palliative Medicine, edn 2. Edited by Doyle D et al. Oxford: Oxford University Press; 1998:909–917.

    Google Scholar 

  23. Coyle N: Focus on the nurse: ethical dilemmas with highly symptomatic patients dying at home. Hospice J 1997, 12:33–41. With earlier hospital discharges and very sick and symptomatic advanced cancer patients being cared for at home, not only the patient but also the family and home care staff needs ongoing expert support and advice. When such support and advice is lacking, the patients’ care is likely to be suboptimal.

    CAS  Google Scholar 

  24. Ward SE, Berry PE, Misiewicz H: Concerns about analgesics among patients and family caregivers. Res Nurs Health 1996, 19:205–211.

    Article  PubMed  CAS  Google Scholar 

  25. Ferrell BR, Ferrell BA, Rhiner M, et al.: Family factors influencing cancer pain management. Post Grad Med J 1991, 67(suppl 2):S64-S69.

    Google Scholar 

  26. Hileman JW, Lackley NR, Hassanein RS: Identifying the needs of home caregivers in patients’ with cancer. Oncol Nurs Forum 1992, 19:771–777.

    PubMed  CAS  Google Scholar 

  27. Warner JE: Involvement of families in pain control of terminally ill patients. In Noninvasive Approaches to Pain Management. New York: Hawthorne Press: 1992:155–169.

    Google Scholar 

  28. Ventafridda V, Selmi S, Di Molar G, et al.: A new model of continuing care for advanced cancer pain treatment. Hospice J 1989, 3:85–99.

    Article  Google Scholar 

  29. Ventafridda V: Continuing care: a major issue in cancer pain management. Pain 1989, 36:137–143.

    Article  PubMed  CAS  Google Scholar 

  30. Ferrell BR, Cohen MZ, Rhiner M, et al.: Pain as a metaphor for illness. Part 1. Impact of cancer pain on family caregivers. Oncol Nurs Forum 1991, 18:1303–1309.

    PubMed  CAS  Google Scholar 

  31. Ferrell BR, Cohen MZ, Rhiner M, et al.: Pain as a metaphor for illness. Part 11. Family caregivers management of pain. Oncol Nurs Forum 1991, 18:1315–1321.

    PubMed  CAS  Google Scholar 

  32. Lobchuk MM, Kristjanson L, Degner L, et al.: Perceptions of symptom distress in lung cancer patients: congruence between patients and primary family caregivers. J Pain Symptom Manage 1997, 14:136–146.

    Article  PubMed  CAS  Google Scholar 

  33. Elliot BA, Elliot TE, Murray DM, et al.: Patient and family members: the role of knowledge and attitudes in cancer pain. J Pain Symptom Manage 1996, 12:209–220.

    Article  Google Scholar 

  34. Ferrell BR, Grant M, Chan J, et al.: The impact of cancer pain education on family caregivers of elderly patients. Oncol Nurs Forum 1995, 22:1211–1218.

    PubMed  CAS  Google Scholar 

  35. Ferrell BR, Borneman T, Juarez G: Integration of pain education in home care. J Palliat Care 1998, 14:62–68.

    PubMed  CAS  Google Scholar 

  36. Kanner RM, Portenoy RK: Unavailability of narcotic analgesics for ambulatory patients in New York City. J Pain Symptom Manage 1986, 1:87–89.

    Article  PubMed  CAS  Google Scholar 

  37. Coyle N, Adelhardt J, Foley KM, et al.: Character of terminal illness: pain and other symptoms during the last 4 weeks of life. J Pain Symptom Manage 1990, 5:83–89.

    Article  PubMed  CAS  Google Scholar 

  38. Bruera E, MacMillan K, Paredes R, et al.: Subcutaneous administration of narcotics for cancer pain: results from 400 patients [meeting abstract]. Pain 1990, 43(suppl 5):497.

    Article  Google Scholar 

  39. Storey P, Hill HH Jr, St Louis RH, et al.: Subcutaneous infusions for the control of cancer symptoms. J Pain Symptom Manage 1990, 5:33–41.

    Article  PubMed  CAS  Google Scholar 

  40. Grond S, Zech D, Schug SA, et al.: Validation of the WHO guidelines for cancer pain relief during the last days and hours of life. J Pain Symptom Manage 1991, 6:411–422.

    Article  PubMed  CAS  Google Scholar 

  41. Coyle N, Cherney N, Portenoy RK: Subcutaneous opioid infusion at home. Oncology 1994, 8:21–27.

    PubMed  CAS  Google Scholar 

  42. Grant M, Ferrell BR, Rivera LM, Lee J: Unscheduled re-admissions for uncontrolled symptoms. Nurs Clin North Am 1995, 30:673–682.

    PubMed  CAS  Google Scholar 

  43. Ferrell BR, Schaffner M: Pharmacoeconomics and medical outcomes in pain management. Semin Anesth 1997, 16:152–159.

    Google Scholar 

  44. Jacox A, Carr DB, Mahrenholz DM, et al.: Cost considerations in patient-controlled analgesia. Pharmacoeconomics 1997, 12(2 Pt 1):109–120.

    Article  PubMed  CAS  Google Scholar 

  45. Egan KA, Labyak MJ: Hospice care: a model for quality end-of-life care. In Palliative Nursing. Edited by Ferrell BR, Coyle N. Oxford: Oxford University Press; 2001:7–26.

    Google Scholar 

  46. Compton P: Substance abuse. In Pain: Clinical Manual, edn 2. Edited by McCaffery M, Passero C. St Louis: Mosby; 1999:428–466.

    Google Scholar 

  47. Passik SD, Portenoy RK: Substance abuse issues in palliative care. In Principles and Practice of Clinical Oncology. Edited by Berger A, Portenoy RK. Philadelphia: Lippincott-Raven Press; 1998:513–529.

    Google Scholar 

  48. Ferrell BA, Ferrell BR: Pain in the nursing home. J Am Geriatr Soc 1990, 38:409–414.

    PubMed  CAS  Google Scholar 

  49. Ferrell BA, Ferrell BR, Rivera LM: Pain in the cognitively impaired nursing home patients. J Pain Symptom Manage 1995, 10:591–598.

    Article  PubMed  CAS  Google Scholar 

  50. Coyle N: Continuity of care for the cancer patient with chronic pain. Cancer Suppl 1989, 63:2289–2293.

    CAS  Google Scholar 

  51. Walsh D: Continuing care in a medical center. The Cleveland Clinic Foundation Palliative Care Service. J Pain Symptom Manage 1990, 5:273–278.

    Article  PubMed  CAS  Google Scholar 

  52. Nauright LP, Moneyham L, Williamson J: Telephone triage and consultation: an emerging role for nurses. Nurs Outlook 1999, 47:219–226.

    Article  PubMed  CAS  Google Scholar 

  53. Du Pen S, Du Pen AR, Polissar N, et al.: Implementing guidelines for cancer pain management: results of a randomized controlled clinical trial. Oncology 1999, 17:361–385. This algorithm uses a step-by-step decision-making tree model involving a comprehensive pain assessment and evidence-based analgesic approach. Assessment and reassessment are a key component of effective algorithm use, the clinician or family member always going back to the patient to ask, "is the pain controlled are you having side effects"?

    Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Rights and permissions

Reprints and permissions

About this article

Cite this article

Coyle, N. Facilitating cancer pain control in the home: Opioid-related issues. Current Science Inc 5, 217–226 (2001). https://doi.org/10.1007/s11916-001-0035-9

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11916-001-0035-9

Keywords

Navigation