Misconceptions on opioid use in pain management must be cleared, says study
The experience of pain among cancer patients is multidimensional and, as such, requires exploration from multiple aspects, according to a study presented at the European Society for Medical Oncology (ESMO) Asia 2018 Congress.
“Healthcare professionals should educate patients to clear misconceptions regarding opioids and thorough pain assessment is essential,” researchers said.
Sixty-two percent of 133 patients had good pain control, but 71 percent still had moderate-to-severe interference with daily activities due to pain. Furthermore, pain intensity was positively associated with daily interference of daily activities (p=0.000) and belief of fatalism (p=0.001). [ESMO Asia 2018, abstract 439P]
Patients with higher education levels were inclined to have strong barriers towards opioids (p=0.000). Significant differences were noted between ethnic groups regarding the perspective of harmful effects of opioid use. Malays recorded stronger barriers, followed by the Chinese and Dayak communities.
“Strong opioids are commonly used to manage severe pain among cancer patients,” researchers said. “However, patients’ misconceptions towards strong opioids result in pain undertreatment, reducing their quality of life.”
In this study, patients completed a survey inquiring their age, gender, ethnic group, religion, education level, occupation and marital status. A visual analogue scale from 0–10 was used to measure pain, while the Brief Pain Inventory short form was utilized to assess the effects of pain.
Patient-related barriers were measured using Barriers Questionnaire-II. Scores were expressed as means with standard deviations. Parametric or nonparametric tests were used to analyse associations, interpreted at 5-percent significance.
According to the ESMO Clinical Practice Guidelines on the management of cancer pain, patients must be informed about the possible onset of pain at any stage of the disease, both during/after diagnostic interventions and as a result of cancer and/or anticancer treatments. [Ann Oncol 2018;29:iv166–iv191]
Patient education must have information on the proper use of opioids, set in context with other analgesic and nonpharmacological approaches. Furthermore, involving patients in pain management improves both communication and pain relief through enhancing both patient understanding and physician assessment and prescribing. [Ann Oncol 2008;19:44-48; Pain 2009;143:192-199; J Clin Oncol 2012;30:539-547]
“It is important to prescribe a therapy that can be managed simply by patients and families themselves. The oral route, if well tolerated, should be considered as the preferred route of administration,” the guidelines stated. [BMJ 1996;312:823-826]
In addition, careful assessment and appropriate management is required in breakthrough cancer pain (BTcP), defined as “a transitory flare of pain that occurs on a background of relatively well-controlled baseline pain.” BTcP episodes are usually of moderate-to-severe intensity, rapid in onset (minutes) and or relatively short duration (median, 30 minutes). [Pain 1990;41:273-281]