Abstract
Nurses have advanced practice, research, and education in the field of cancer pain management. This paper highlights the contributions nurses have made to pain science and practice through literature published in the past 3 years. Work accomplished by nurses is examined in the areas of pain assessment, pain management, intervention-based research, evidence-based practice, patient education, and palliative care. Nurses serve as advocates for empowering patients to engage in self-management of their pain, and offer education and support to patients and families at their most vulnerable times. Nurse researchers have been at the forefront of work to develop and test new instruments and approaches to measure pain, elucidate pain experiences through quantitative and qualitative methodologies, and gauge the quality of pain care for patients and its impact on their caregivers. This research has uncovered many patient, health care professional, and systemic barriers to effective pain control, and has offered feasible solutions to overcoming these barriers.
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Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance
Lavoie Smith EM, Bakitas MA, Homel P, et al. Using quality improvement methodology to improve neuropathic pain screening and assessment in patients with cancer. J Cancer Educ. 2009;24:135–40.
Herr K, Titler M, Fine P, et al. Assessing and treating pain in hospices: current state of evidence-based practices. J Pain Symptom Manage. 2010;39:803–19.
Wells N, McDowell MR, Hendricks P, et al.: Cancer pain management in ambulatory care: can we link assessment and action to outcomes? Support Care Cancer 2010, Oct 30. [in press]
Gordon DB, Polomano RC, Pellino TA, et al. Revised American Pain Society Patient Outcome Questionnaire (APS-POQ-R) for quality improvement of pain management in hospitalized adults: preliminary psychometric evaluation. J Pain. 2010;11:1172–86.
Beck SL, Towsley GL, Berry PH, et al. Measuring the quality of care related to pain management: a multiple-method approach to instrument development. Nurs Res. 2010;59:85–92.
Lui F, Ng KF. Adjuvant analgesics in acute pain. Expert Opin Pharmacother. 2011;12:363–85.
Argoff CE, Albrecht P, Irving G, Rice F. Multimodal analgesia for chronic pain: rationale and future directions. Pain Med. 2009;10 Suppl 2:S53–66.
Polomano RC, Dunwoody CJ, Krenzischek DA, Rathmell JP. Perspective on pain management in the 21st century. Pain Manag Nurs. 2008;9(1 Suppl):S3–10.
Chou R, Fanciullo GJ, Fine, et al. American Pain Society-American Academy of Pain Medicine Opioids Guidelines Panel. Clinical guidelines for the use of chronic opioid therapy in chronic noncancer pain. J Pain. 2009;10:113–30.
Fine PG. Clinical approaches to special issues related to opioid therapy. Semin Oncol Nurs. 2009;25(2 Suppl 1):S20–8.
Vissers KC, Besse K, Hans G, et al. Opioid rotation in the management of chronic pain: where is the evidence? Pain Pract. 2010;10:85–93.
Shaheen PE, Walsh D, Lasheen W, Davis MP, Lagman RL. Opioid equianalgesic tables: are they all equally dangerous? J Pain Symptom Manage. 2009;38:409–17.
Webber K, Davies AN, Cowie MR: Breakthrough pain: a qualitative study involving patients with advanced cancer. Support Care Cancer 2010, Dec 22.
Rhiner MI, von Gunten CF. Cancer breakthrough pain in the presence of cancer-related chronic pain: fact versus perceptions of health-care providers and patients. J Support Oncol. 2010;8:232–8.
•• Haugen DF, Hjermstad MJ, Hagen N, et al.: Caraceni A, Kaasa S; European Palliative Care Research Collaborative (EPCRC). Assessment and classification of cancer breakthrough pain: a systematic literature review. Pain 2010, 149:476–82. This article describes a systematic review of published literature on cancer BTP to determine validation of terms, assessment, and domains.
Bobb BT, Coyne PJ. When cancer pain breaks through, what can you do? Oncology (Williston Park). 2010;24(10 Suppl):13–8.
Mercadante S: The use of rapid onset opioids for breakthrough cancer pain: The challenge of its dosing. Crit Rev Oncol Hematol 2011, Jan 5. [Epub ahead of print]
Carr DB, Goudas LC. Acute pain Lancet. 1999;353:2051–58.
Latremoliere A, Woolf CJ. Central sensitization: a generator of pain hypersensitivity by central neural plasticity. J Pain. 2009;10:895–926.
Fernández-Lao C, Cantarero-Villanueva I, Fernández-de-las-Peñas C, et al. Widespread mechanical pain hypersensitivity as a sign of central sensitization after breast cancer surgery: comparison between mastectomy and lumpectomy. Pain Med. 2011;12:72–8.
Steegers MA, Wolters B, Evers AW, et al. Effect of axillary lymph node dissection on prevalence and intensity of chronic and phantom pain after breast cancer surgery. J Pain. 2008;9:813–22.
Wenk M, Schug SA. Perioperative pain management after thoracotomy. Curr Opin Anaesthesiol. 2011;24:8–12.
Amr YM, Yousef AA. Evaluation of efficacy of the perioperative administration of Venlafaxine or gabapentin on acute and chronic postmastectomy pain. Clin J Pain. 2010;26:381–5.
Gerner P. Postthoracotomy pain management problems Anesthesiol Clin. 2008;26:355–67.
McClellan MB, McGinnis M, Nabel EG, et al.: Evidence based medicine and the changing nature of health care. National Academies Press 2008. http://www.nap.edu.
National Guideline Clearinghouse: Clinical practice guidelines. Available at http://www.guidelines.gov. Accessed January 2011.
Oncology Nursing Society: Pain clinical resource area. Available at http://www.ons.org/ClinicalResources/Symptom/Pain. Accessed January 2011.
National Comprehensive Cancer Network: NCCN guidelines. Available at http://www.nccn.org/professionals/physician_gls/f_guidelines.asp. Accessed January 2011.
National Consensus Project for Quality Palliative Care: Clinical practice guidelines. Available at http://www.nationalconsensusproject.org/AboutGuidelines.asp. Accessed February 2011.
Bennett MI, Bagnall AM, José Closs S. How effective are patient-based educational interventions in the management of cancer pain? Systematic review and meta-analysis. Pain. 2009;143:192–9.
• Lovell MR, Forder PM, Stockler MR, et al.: A randomized controlled trial of a standardized educational intervention for patients with cancer pain. J Pain Symptom Manage 2010, 40:49–59. This paper describes a study to determine whether an educational intervention consisting of a video and/or booklet for adults with cancer pain could improve knowledge and attitudes about cancer pain management, pain levels, pain interference, anxiety, quality of life, and analgesic use.
• Haozous E, Doorenbos AZ, Demiris G, et al.: Role of telehealth/videoconferencing in managing cancer pain in rural American Indian communities. Psychooncology 2010, Dec 22. [In press]. This paper describes a study to determine the feasibility and effect of using videoconferencing to deliver cancer-related pain-management education and case consultation to health care providers in rural American Indian and Alaskan Native communities.
Simone 2nd CB. Vapiwala N, Hampshire MK, Metz JM: Internet-based survey evaluating use of pain medications and attitudes of radiation oncology patients toward pain intervention. Int J Radiat Oncol Biol Phys. 2008;72:127–33.
• Kroenke K, Theobald D, Wu J, et al.: Effect of telecare management on pain and depression in patients with cancer. JAMA 2010, 304:163–171. These authors describe a study demonstrating that centralized telecare management coupled with automated symptom monitoring resulted in improved pain and depression outcomes in cancer patients in geographically dispersed urban and rural oncology practices.
Ward SE, Wang KK, Serlin RC, et al. A randomized trial of a tailored barriers intervention for Cancer Information Service (CIS) callers in pain. Pain. 2009;144:49–56.
Yildirim YK, Cicek F, Uyar M. Effects of pain education program on pain intensity, pain treatment satisfaction, and barriers in Turkish cancer patients. Pain Manag Nurs. 2009;10:220–8.
• Vallerand, AH, Hasenau, SM, & Templin, T. Improving cancer pain management in the home. J Pain Manage 2010, 3, 41–52. This article describes a randomized control trial of an educational intervention for home care nurses, patients, and caregivers to improve cancer pain management in home care patients.
Smith MY, DuHamel KN, Egert J, Winkel G. Impact of a brief intervention on patient communication and barriers to pain management: results from a randomized controlled trial. Patient Educ Couns. 2010;81:79–86.
Fahey KF, Rao SM, Douglas MK, et al. Nurse coaching to explore and modify patient attitudinal barriers interfering with effective cancer pain management. Oncol Nurs Forum. 2008;35:233–40.
• Jahn P, Kitzmantel M, Renz P, et al.: Improvement of pain related self management for oncologic patients through a trans institutional modular nursing intervention: protocol of a cluster randomized multicenter trial. Trials 2010, 11:29. This article describes a multicenter, modular intervention (pharmacologic pain management, nonpharmacologic pain management, and discharge management) to improve self-management in patients with cancer pain.
• Kravitz RL, Tancredi DJ, Street RL Jr, et al.: Cancer Health Empowerment for Living without Pain (Ca-HELP): study design and rationale for a tailored education and coaching intervention to enhance care of cancer-related pain. BMC Cancer 2009, 9:319. This article describes a randomized control trial of patients with cancer pain receiving either tailored education and coaching delivered by lay health educators or educationally enhanced usual care.
Mosher CE, Duhamel KN, Egert J, Smith MY. Self-efficacy for coping with cancer in a multiethnic sample of breast cancer patients: associations with barriers to pain management and distress. Clin J Pain. 2010;26:227–34.
Edrington J, Sun A, Wong C, et al. Barriers to pain management in a community sample of Chinese American patients with cancer. J Pain Symptom Manage. 2009;37:665–75.
• Martin MY, Pollack LA, Evans MB, et al.: Tailoring cancer education and support programs for low-income, primarily African American cancer survivors. Oncol Nurs Forum 2011, 38:E55-9. This paper identified the information and stress-management topics of most interest to low-income, predominantly African American cancer survivors.
Im EO, Lee SH, Liu Y, et al. A national online forum on ethnic differences in cancer pain experience. Nurs Res. 2009;58:86–94.
Williams PD, Lopez V, Ying CS, et al. Symptom monitoring and self-care practices among oncology adults in China. Cancer Nurs. 2010;33:184–93.
• Ferrell B: Palliative care research: nursing response to emergent society needs. Nurs Sci Q 2010, 23:221–225. This article describes a body of research on palliative and end-of-life care.
Soden K, Ali S, Alloway L, et al. How do nurses assess and manage breakthrough pain in specialist palliative care inpatient units? A multicentre study. Palliat Med. 2010;24:294–8.
Fouladbakhsh J, Stommel M. Gender, symptom experience, and use of complementary and alternative medicine practices among cancer survivors in the U.S. cancer population. Oncol Nurs Forum. 2010;37:E7–E15.
Van Breeman C. Using play therapy in paediatric palliative care: listening to the story and caring for the body. Int J Palliat Nurs. 2009;15:510–4.
Lewis R, Neal RD, Williams NH, et al. Nurse-led vs. conventional physician-led follow up for patients with cancer: systematic review. J Adv Nurs. 2009;65:706–23.
•• Bookbinder M, Glajchen M, McHugh M, et al.: Nurse practitioner-based models of specialist palliative care at home: sustainability and evaluation of feasibility. J Pain Symptom Manage 2011, 41:25–34. This feasibility study demonstrated the benefits and cost-effectiveness of a hospice NP model for hospice care.
Beck SL, Towsley GL, Caserta MS, et al. Symptom experiences and quality of life of rural and urban older adult cancer survivors. Cancer Nurs. 2009;32:359–69.
Melin-Johansson C, Axelsson B, Gaston-Johansson F, Danielson E. Significant improvement in quality of life of patients with incurable cancer after designation to a palliative homecare team. Eur J Cancer Care (Engl). 2010;19:243–50.
Deglin JH, Vallerand AH, Sanoski CA. Davis’s Drug Guide for Nurses. 12th ed. Philadelphia: Davis; 2011.
Nguyen TN, Nilsson S, Hellstrom AL, et al. Music therapy to reduce pain and anxiety in children with cancer undergoing lumbar puncture: a randomized clinical trial. JOPON. 2010;27:146–55.
Given CW, Given BA, Sikorskii A, et al. Deconstruction of nurse-delivered patient self-management interventions for symptom management: factors related to delivery enactment and response. Ann Behav Med. 2010;40:99–113.
Huang ST, Good M, Zauszniewski JA. The effectiveness of music in relieving pain in cancer patients: a randomized controlled trial. Int J Nurs Stud. 2010;47:1354–62.
Kimman ML, Bloebaum MMF, Dirksen CD, et al. Patient satisfaction with nurse-led telephone follow-up after curative treatment for breast cancer. BMC Cancer. 2010;10:174.
Beaver K, Tysver-Robinson D, Campbell M, et al. Comparing hospital and telephone follow up after treatment for breast cancer: randomized equivalence trial. BMJ. 2009;338:a3147.
Borneman T, Koczywas M, Chih-Yi Sun V, et al. Reducing patient barriers to pain and fatigue management. J Pain Symptom Manage. 2010;39:486–501.
Coleman EA, Coon SK, Lockhart K, et al. Effect of certification in oncology nursing on nursing sensitive outcomes. Clin J Oncol Nurs. 2009;13:165–72.
Brant JM. Practical approaches to pharmacologic management of pain in older adults with cancer. Oncol Nurs Forum. 2010;37:17–26.
Disclosures
Dr. April H. Vallerand has served on the Nurses Advisory Board for Cephalon and on the Speaker’s Bureau for Cephalon and Pfizer & Co. Susan Musto: none. Dr. Rosemary C. Polomano has served on the board for AcelRx Pharmaceutical; and has served as a consultant for, and received honoraria from, King Pharmaceutical, Ortho McNeil Pharmaceutical, Wyeth Pharmaceutical, and Pfizer & Co.
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Vallerand, A.H., Musto, S. & Polomano, R.C. Nursing’s Role in Cancer Pain Management. Curr Pain Headache Rep 15, 250–262 (2011). https://doi.org/10.1007/s11916-011-0203-5
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DOI: https://doi.org/10.1007/s11916-011-0203-5