Pain and quality of life of cancer patients: a multi-center study in Thailand.

OBJECTIVE: To identify the association between Quality Of Life (QOL) and pain intensity, and the magnitude of change of pain scores that have a clinically significant impact on patients' QOL. DESIGNS: Multi-center; prospective cohort study. MATERIAL AND METHOD: Patients suffering from cancer pain were recruited from seven university hospitals and three tertiary care centers in Thailand. The FACT-G and the Brief Pain Inventory were used to assess QOL and cancer pain severity, respectively, at study entry and at two-week follow-up. RESULTS: Five-hundred-and-twenty patients were recruited with a mean age of 52. The majority (76%) reported two sites of pain with 80% being treated at either step 2 or 3 (WHO guidelines of pain management). After two weeks, the average level of maximum pain was reduced from 6.6 to 4.8 (mean difference = -1.8, p < 0.001) and the QOL was improved from 58.6 to 61.0 (mean difference = 2.4, p < 0.001). There was a high correlation between the average change of pain intensity and QOL scores (rs = -0.42, p < 0.001). The results show that changes of pain scores of at least three points (3 out of 10) were required for a minimal important difference of FACT-G scores, indicating a significant change on patients' QOL. Pain deterioration had slightly more impact on QOL than pain improvement. A 3-point pain deterioration impaired QOL 10.3 points while 3-point reduction increased QOL only 7.6 points. CONCLUSION: The present findings suggest the importance of pain management. The change of pain scores of at least three points (out of 10 points) had statistical and clinical significance to patients' QOL.

Single dose oral clonidine premedication does not enhance postoperative, single low dose epidural morphine analgesia in hysterectomy patients.

In this randomized, double blind placebo controlled study, the authors evaluated the effects of oral clonidine premedication on very low dose epidural morphine analgesia in 50 hysterectomy patients. Patients were randomized to receive a single oral clonidine 300 microg (n = 25) or a placebo (n = 25) 90 minutes before insertion of the epidural catheter. 3 ml of 2% lidocaine with adrenaline (5 microg ml(-1) mixed with 2 mg morphine were injected via epidural, followed by an additional volume of 2% lidocaine with adrenaline (5 microg ml(-1)) titrated to T6 block height before commencing general anesthesia. The postoperative analgesia regimen was 2 mg of intravenous morphine every 10 minutes for the first 48 hr and 1 gm of oral acetaminophen every 4-6 hr after initiation of oral diet at 24-48 hr as required. Morphine consumption, acetaminophen, pain scores, and side effects were recorded thoughout 48 hr after surgery. The results show patients in the clonidine and placebo groups were not different in terms of local anesthetics dose (p = 0.27), total morphine and acetaminophen requirement (p = 0.34, p = 0.1) respectively. Pain scores at rest and movement were also not different in both groups (p = 0.83, p = 0.64) respectively. No serious adverse effects were noted. The authors concluded that oral clonidine approximately 6 microg kg(-1) does not enhance the analgesic effect of epidural morphine 2 mg after hysterectomy.

A chart audit of postoperative pain assessment and documentation: the first step to implement pain assessment as the fifth vital sign in a University Hospital in Thailand.

PURPOSE: To describe the documentation of pain assessment and management in the first 72 hrs postoperatively. DESIGNS: Retrospective descriptive study MATERIAL AND METHOD: Four hundred and twenty five hospital charts in December 2002 were audited to reveal the quality of postoperative pain assessment and documentation. Scores above 21 from the possible maximum of 28 (75%) were accepted for the review. RESULTS: Nurses documented pain assessment more often than doctors (98.8% vs 29.4%). An assessment of pain intensity using a numerical rating scale (0 to 10) was found in 192 (45.2%) charts, and using a pain descriptor scale in 408 (96%) charts. The documentation of pain both before and after giving analgesics was scarce during the first 3 days postoperatively. Apart from charts that used a patient-controlled analgesia (PCA) technique which had a specific record form, regular pain assessment every 2 to 4 hrs during the first 24 hrs was found in only 2 (0.5%) charts. Pain assessment items which were documented inconsistently and below accepted standards were pain assessment after administration of analgesics, pain assessment every 2 hours in the first 24 hours (day 1), and pain assessment thereafter every 4 hours in the first 24-72 hours (days 2 and 3). The other 4 of 7 audit pain items were documented in higher scores: initial patients' pain intensity and sedation assessment, pain treatment, continuity of pain assessment and pain assessor s name scores. Nevertheless, because of the low total audit score [mean+/-SD = 10.7+/-3 out of 28], it was considered that none of the reviewed charts reflected good quality pain assessment and documentation. CONCLUSION: The present study revealed that the existing practices of pain assessment and documentation were poor. The need for development of regular pain assessment as if pain is the fifth vital sign should be widely emphasized as a part of quality assurance.