Breakthrough pain characteristics and syndromes in patients with cancer pain. An international survey.

Breakthrough pain (BKP) is a transitory flare of pain that occurs on a background of relatively well controlled baseline pain. Previous surveys have found that BKP is highly prevalent among patients with cancer pain and predicts more severe pain, pain-related distress and functional impairment, and relatively poor quality of life. An international group of investigators assembled by a task force of the International Association for the Study of Pain (IASP) evaluated the prevalence and characteristics of BKP as part of a prospective, cross-sectional survey of cancer pain. Fifty-eight clinicians in 24 countries evaluated a total of 1095 patients with cancer pain using patient-rated items from the Brief Pain Inventory (BPI) and observer-rated measures. The observer-rated information included demographic and tumor-related data, the occurrence of BKP, and responses on checklists of pain syndromes and pathophysiologies. The clinicians reported BKP in 64.8% of patients. Physicians from English-speaking countries were significantly more likely to report BKP than other physicians. BKP was associated with higher pain scores and functional interference on the BPI. Multivariate analysis showed an independent association of BKP with the presence of more than one pain, a vertebral pain syndrome, pain due to plexopathy, and English-speaking country. These data confirm the high prevalence of BKP, its association with more severe pain and functional impairment, and its relationship to specific cancer pain syndromes. Further studies are needed to characterize subtypes of BKP. The uneven distribution of BKP reporting across pain specialists from different countries suggests that more standardized methods for diagnosing BKP are needed.

Evaluation of a cancer pain education program for general practitioners.

OBJECTIVE: To evaluate a cancer pain education program. METHOD: Participants in the program completed an evaluation form covering various aspects of the program's design. RESULTS: All participants who completed the program were glad that they had done so. The most and least useful aspects are included in the article. Participants were satisfied with the program and eager to participate in similar ones. CONCLUSION: The education program was both successful at improving participants' knowledge of cancer pain management and provided in a manner acceptable to the participants. Ideas for future similar projects are included.

Cancer pain management. Improving knowledge and patient care.

OBJECTIVE: A pain management project was designed to assess the effectiveness of a multifaceted intervention for improving GPs' knowledge of cancer pain management. Two hypotheses were tested: that the intervention would influence GPs' knowledge in the area of cancer pain management; that information would be gathered to assist in the production of educational material. METHOD: The project involved assessment of GP knowledge, feedback and discussion at project officer visits, mailings and participation in developing guidelines. RESULTS: All participants who completed the second round of visits were glad they had participated in the program. A discussion of the information topics covered is included. CONCLUSION: Increasing GPs' knowledge of the management of symptoms is only one of many factors that influence their prescribing patterns. In cancer pain management lack of knowledge is a significant contributor to unnecessary patient suffering. We have been able to demonstrate the success of a multifaceted intervention in improving the knowledge of cancer pain management by GPs. Although not measured directly, it is hoped that this will lead to improved quality of life for patients cared for by these practitioners.