Cancer pain management at a tertiary care cancer center in India—A retrospective analysis of 3,238 patients

Sushma Bhatnagar, MD; Seema Mishra, MD; Madhurima Srikanti, MD; Deepak Gupta, MD

doi:10.5055/jom.2008.0040

Authors

Sushma Bhatnagar, MD
Seema Mishra, MD
Madhurima Srikanti, MD
Deepak Gupta, MD

DOI:

https://doi.org/10.5055/jom.2008.0040

Keywords:

cancer pain management, WHO analgesic ladder, opioids

Abstract

Effective pain control is essential for the management of patients with cancer. About 70-80 percent of patients with cancer present in an advanced stage of disease. Patients with advanced cancer frequently experience intractable pain, with diverse symptoms that can make daily living impossible and affect the quality of life. This article reports the management of 3,238 patients with cancer pain over a period of five years. Nearly 89.6 percent patients had good pain relief, with Visual Analogue Scale score less than 3. These promising results were achieved by careful patient assessment, close liaison with clinicians from other specialties, and using a variety of analgesic regimen including oral analgesics, anesthetic procedures, psychological interventions, and supportive care. However, the main stay of treatment was oral analgesics, following the principles of World Health Organization ladder, with continuing follow-up.

Author Biographies

Sushma Bhatnagar, MD

Unit of Anaesthesiology, Pain and Palliative Care, Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India.

Seema Mishra, MD

Unit of Anaesthesiology, Pain and Palliative Care, Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India.

Madhurima Srikanti, MD

Unit of Anaesthesiology, Pain and Palliative Care, Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India.

Deepak Gupta, MD

Unit of Anaesthesiology, Pain and Palliative Care, Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India.

References

Vainio A, Auvuinen A: Prevalence of symptoms among patients with advanced cancer: An international collaborative study. J Pain Symptom Manage. 1996; 12: 3-10.

Sloan PA, Donnelly MB, Schwatz RW, et al.: Cancer pain assessment and management by house staff. Pain. 1996; 67: 475-481.

Grond S, Zech D, Dorr V: Cancer pain management according to WHO analgesic guidelines. J Pain Symptom Manage. 1991; 6: 411-422.

Schug SA, Zech D, Dorr U: Cancer pain management according to WHO analgesic guidelines. J Pain Symptom Manage. 1990; 5: 27-32.

Ventafridda V, Tamburini M, Caraceni A, et al.: A validation study of the WHO method for cancer pain relief. Cancer. 1987; 59: 850-856.

Walker VA, Hoskin PJ, Hanks GW, et al.: Evaluation of WHO guidelines for cancer pain in a hospital-based palliative care unit. J Pain Symptom Manage. 1988; 3: 145-149.

Zech DF, Grond S, Lynch J, et al.: Validation of World Health Organization Guidelines for cancer pain relief: A 10-year prospective study. Pain. 1995; 63: 65-76.

Ventafridda V, Carcenti A, Gamba A: Field-testing of the WHO guidelines for cancer Pain relief: Summarry of demonstration Projects. In Foly KM, Bonica JJ, Ventafridda V (eds). Proceedings of the Second International Congress on Pain, Vol. 16: Advances in Pain and Research and Therapy. New York: Raven Press, 1990;51-64.

Sloan PA, Melzack R: Long-term patterns of morphine dosage and pain intensity among cancer patients. Hosp J. 1999; 14: 35-47.

Lema MJ: Invasive procedures for cancer pain. Pain Clin Updat. 1998; 6: 1-4.

Yu S, Wang XS, Cheng Y: Special aspects of cancer pain management in Chinese general hospital. Eur J Pain. 2005; 5(SupplA): 15-20.

Callaghan JP: Evolution of a rational use of opoids in chronic pain. Eur J Pain. 2005; 5(SupplA): 21-26.

Lickiss JN: Approaching cancer pain relief. Eur J Pain. 2001; 5(SupplA): 5-14.

Pahwa M, Babu N, Bhatnagar S: Fighting cancer is half the battle . . . Living life is the other half. J Can Res Ther. 2005; 1: 98-102.