Effects of Good Pain Management (GPM) ward program on patterns of care and pain control in patients with cancer pain in Taiwan

Wei-Chih Su, Chieh-Han Chuang, Fang-Ming Chen, Hsiang-Lin Tsai, Ching-Wen Huang, Tsung-Kun Chang, Ming-Feng Hou, Jaw-Yuan Wang, Wei-Chih Su, Chieh-Han Chuang, Fang-Ming Chen, Hsiang-Lin Tsai, Ching-Wen Huang, Tsung-Kun Chang, Ming-Feng Hou, Jaw-Yuan Wang

Abstract

Background: The undertreatment of cancer pain is a global issue although many international guidelines and various studies bloom to explore the approaches in pain management. However, there is no standard care for cancer pain in routine practices. To set up a standardized procedure for improving cancer pain management in Taiwan, the Good Pain Management (GPM) program is explored to provide treatments following the US National Cancer Care Network (NCCN) Adult Cancer Pain Guideline.

Method: Patients diagnosed with moderate-to-severe cancer pain were eligible and randomized into the GPM or control arm and observed the first 48 h to evaluate the effects of pain management between 2 arms. Pain control, adequacy of treatments, patient satisfaction, and quality of life (QoL) of eligible patients were analyzed. Ad hoc analyses based on the pain medication category were also conducted.

Result: Fifty-one patients were enrolled, with 26 and 25 assigned to the GPM and control arms, respectively. Significant differences among the GPM and control arms were found including a greater decrease in the mean numerical rating scale (NRS) score in the GPM arm (- 4.6 vs. - 2.8), a lower proportion of moderate-to-severe pain in the GPM arm (23.2% vs. 39.8%), and a higher pain management index (PMI) score in the GPM arm (0.64 points vs. 0.33 points) (all p < 0.05). Ad hoc analyses revealed that the patient subgroups using strong opioids showed better patient satisfaction in GPM arm when compared with the same subgroup in the control arm.

Conclusion: In summary, our study demonstrated that the implementation of a standardized pain assessment and management approach (GPM ward program) showed significant improvements on pain relief, decreased the portion of moderate-to-severe cancer pain, and increased patient satisfaction in the 1st 48 h after admission. The implementation of the GPM approach in the cancer ward may provide sooner and better improvement of cancer pain management for patients who suffered moderate-to-severe cancer pain.

Trial registration: ClinicalTrials.gov (Identifier: NCT03155516).

Keywords: Adequacy of pain treatment; Cancer pain; Good pain management; Pain control.

Conflict of interest statement

The authors declare that they have no conflict of interest.

Figures

Fig. 1
Fig. 1
Good pain management—algorithm
Fig. 2
Fig. 2
Flow chart
Fig. 3
Fig. 3
A comparison of change in the NRS score between the GPM and control arms. NRS, numerical rating scale; GPM, good pain management; EOT, end of treatment. *p = 0.0013
Fig. 4
Fig. 4
The frequency of pain reported in the GPM and control arms. GPM, good pain management. *p < 0.0001
Fig. 5
Fig. 5
The difference between the GPM and control arms using APS-POQ. a. Patient satisfaction *p = 0.724. b Overall outcomes. APS-POQ, American Pain Society Patient Outcome Questionnaire; GPM, good pain management. All p > 0.05
Fig. 6
Fig. 6
The frequency of pain reporting in the GPM and control arms—ad hoc subgroup analysis based on the pain medication category (strong opioid group and non-opioid group). *p = 0.4046; **p = 0.0132, chi-square test
Fig. 7
Fig. 7
The ad hoc subgroup analysis of patient satisfaction (APS-POQ). Comparison on patient satisfaction on GPM and control ward among the same patient groups (strong opioid group and non-opioid group, *p = 0.0329; **p = 0.8697, independent two-sample t-test)

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