Exploration the Results of Cancer Pain Management Following Implementation of World Health Organization (WHO) Pain Guideline

Abstract

Background: Pain is among the most common symptoms encountered in cancer patients and remains the first priority of care. Methods: This cross sectional study aimed to explore a result of pain management at Srinagarind Hospital, Khon Kaen University following the implementation of World Health Organization (WHO) Pain Guideline. Cancer pain patients were categorized based on prior analgesic exposure into two groups; Naïve group, and Routine group. Treatments were defined according to WHO as 1) drug treatment relevant to pain severity, 2) analgesics being prescribed as around-the-clock and 3) analgesics used for break-through pain for patients receiving strong opioids. Results: From Dec 2005 to Jul 2006, 261 patients were enrolled, 93.1% (n=243) were in advanced stages and 88.5% (n=231) were in moderate to severe pain. In Naïve group (n=159), 32.7% (n=52) of patients were given analgesics following the WHO on both day 1 and day 3 of admissions; 3.8% (n=6) of patients followed WHO only on day 1; 23.3% (n=37) of patients followed WHO only on day 3 whereas 40.2% (n=64) of patients did not follow WHO on both days. A decreased pain score was greater (2.61, SD±1.5) in a group following the WHO both days on day 1 and a decreased pain score was much improved (3.9, SD±1.8) as continuing to follow WHO on day 3 (p < 0.0001) compared to those not following WHO on both days. In Routine group (n=102), 31.4% (n=32) of patients were given analgesics following WHO guideline on both day 1 and day 3 of admission. 5.9% (n=6) of patients followed WHO only on day 1; 27.5% (n=28) of patients followed WHO only day 3 while 35.3% (n=36) of patients did not follow WHO on both days. A decreased pain score was statistically significant greater (2.6, SD±1.8) in a routine group following the WHO both days on day 1 (p < 0.0001). Furthermore, a decreased pain score was even greater (3.9, SD±2.3) in the routine group continuing to follow WHO on day 3 compared to those not following WHO on both day 1 and day 3 of admission. The most common of adverse effects related to analgesics was constipation. Conclusions: The results demonstrated that patients who received pain management following the WHO guideline reported significantly lower pain intensity than those not following the WHO regardless the history of analgesics exposure.