Barriers to cancer pain management in Danish and Lithuanian patients treated in pain and palliative care units.

The prevalence of cancer-related pain is high despite available guidelines for the effective assessment and management of that pain. Barriers to the use of opioid analgesics partially cause undertreatment of cancer pain. The aim of this study was to compare pain management outcomes and patient-related barriers to cancer pain management in patient samples from Denmark and Lithuania. Thirty-three Danish and 30 Lithuanian patients responded to, respectively, Danish and Lithuanian versions of the Brief Pain Inventory pain scale, the Barriers Questionnaire II, the Hospital Anxiety and Depression Scale, the Specific Questionnaire On Pain Communication, and the Medication Adherence Report Scale. Emotional distress and patient attitudes toward opioid analgesics in cancer patient samples from both countries explained pain management outcomes in the multivariate regression models. Pain relief and pain medication adherence were better in Denmark, and the country of origin significantly explained the difference in the regression models for these outcomes. In conclusion, interventions in emotional distress and patient attitudes toward opioid analgesics may result in better pain management outcomes generally, whereas poor adherence to pain medication and poor pain relief appear to be more country-specific problems.

Barriers to pain management among Lithuanian cancer patients.

OBJECTIVES: The objectives of this study are (1) to describe Lithuanian cancer patients' barriers to pain management as well as pain management outcomes, (2) to check the reliability and validity of the questionnaires used in Lithuanian for the first time, and (3) to formulate patient-centered recommendations for better cancer pain management. METHODS: Thirty patients from the Pain Clinic of Kaunas University of Medicine Hospital responded to the Lithuanian versions of: (1) Brief Pain Inventory pain scale, (2) Barriers Questionnaire-II, (3) Hospital Anxiety and Depression Scale, (4) Modified version of the Perceived Involvement in Care Scale, and (5) Medication Adherence Report Scale. RESULTS: The translated questionnaires had fear internal consistency reliability and construct validity. Reported average (standard deviation [SD]) pain intensity among Lithuanian cancer patients was 3.9 (1.30) on a scale 0-10. The mean (SD) scores of anxiety and depression among the surveyed patients were 8.7 (4.86) and 7.5 (5.05) on a scale 0-21, respectively. The percentage of the patients, who reported stopping taking pain medicine because of its side effects, was 33.3%. The biggest patients' concerns were about physiological consequences and harmful effects of opioid use. The average (SD) level of perceived communication among Lithuanian patients was 3.1 (0.95) on a scale 0-5, whereas the average level (SD) of self-reported adherence to pain medication among Lithuanians was 13.0 (3.65) on a scale 4-20. CONCLUSIONS: The authors believe, that to improve cancer pain management in Lithuania (1) more attention should be paid to psychological status of patients, (2) patients should be more educated about the need and consequences of opioid use for cancer pain, and (3) adherence to pain management regimens should be improved.

Barriers to cancer pain management: a review of empirical research.

Patient-, physician-, and health care system-related barriers of cancer pain management in patients with malignant diseases are a recognized and widely investigated issue. The purpose of this review is to summarize the main findings of empirical research on these barriers in the literature. The most significant patient-related barriers were patient reluctance to report pain and adhere to treatment recommendations. Besides that, cognitive, affective, and sensory patient-related barriers to cancer pain management with opioid analgesics have been studied using quantitative and qualitative research methods. The Barriers Questionnaire and its shortened and modified versions were the most commonly used instruments in the context of research on patient-related barriers to cancer pain management. The most prominent physician-related barriers were insufficient physicians' knowledge about cancer pain management, inadequate patterns of pain assessment, and inadequate opioid prescription. The methodologies used to conduct the majority of the studies on physician-related barriers were weak. Nevertheless, physician knowledge of pain management guidelines, the quality of pain assessment and opioid prescription have been shown to be obviously better in a few Western countries. Institutional and health care system-related barriers were relevant only in countries with restrictive opioid prescription regulations. The evaluation of the influence of cultural-social-economical background on cancer pain management could probably help to obtain better insight into the problems of unrelieved cancer pain.