Skip to main page content
Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Multicenter Study
. 1994 Mar 3;330(9):592-6.
doi: 10.1056/NEJM199403033300902.

Pain and Its Treatment in Outpatients With Metastatic Cancer

Affiliations
Free article
Multicenter Study

Pain and Its Treatment in Outpatients With Metastatic Cancer

C S Cleeland et al. N Engl J Med. .
Free article

Abstract

Background and methods: Pain is often inadequately treated in patients with cancer. A total of 1308 outpatients with metastatic cancer from 54 treatment locations affiliated with the Eastern Cooperative Oncology Group rated the severity of their pain during the preceding week, as well as the degree of pain-related functional impairment and the degree of relief provided by analgesic drugs. Their physicians attributed the pain to various factors, described its treatment, and estimated the impact of pain on the patients' ability to function. We assessed the adequacy of prescribed analgesic drugs using guidelines developed by the World Health Organization, studied the factors that influenced whether analgesia was adequate, and determined the effects of inadequate analgesia on the patients' perception of pain relief and functional status.

Results: Sixty-seven percent of the patients (871 of 1308) reported that they had had pain or had taken analgesic drugs daily during the week preceding the study, and 36 percent (475 of 1308) had pain severe enough to impair their ability to function. Forty-two percent of those with pain (250 of the 597 patients for whom we had complete information) were not given adequate analgesic therapy. Patients seen at centers that treated predominantly minorities were three times more likely than those treated elsewhere to have inadequate pain management. A discrepancy between patient and physician in judging the severity of the patient's pain was predictive of inadequate pain management (odds ratio, 2.3). Other factors that predicted inadequate pain management included pain that physicians did not attribute to cancer (odds ratio, 1.9), better performance status (odds ratio, 1.8), age of 70 years or older (odds ratio, 2.4), and female sex (odds ratio, 1.5). Patients with less adequate analgesia reported less pain relief and greater pain-related impairment of function.

Conclusions: Despite published guidelines for pain management, many patients with cancer have considerable pain and receive inadequate analgesia.

Comment in

  • Treating cancer pain.
    Karnad AB. Karnad AB. N Engl J Med. 1994 Jul 21;331(3):199; author reply 201. doi: 10.1056/NEJM199407213310313. N Engl J Med. 1994. PMID: 7516494 No abstract available.
  • More on the treatment of pain.
    De Salles AA, Johnson JP. De Salles AA, et al. N Engl J Med. 1994 Dec 1;331(22):1528. doi: 10.1056/NEJM199412013312217. N Engl J Med. 1994. PMID: 7969315 No abstract available.
  • Treating cancer pain.
    Goodman AN. Goodman AN. N Engl J Med. 1994 Jul 21;331(3):200; author reply 201. N Engl J Med. 1994. PMID: 8008037 No abstract available.
  • Treating cancer pain.
    O'Neill WM, Chambers EJ, Fallon MT. O'Neill WM, et al. N Engl J Med. 1994 Jul 21;331(3):200; author reply 201. N Engl J Med. 1994. PMID: 8008038 No abstract available.

Similar articles

See all similar articles

Cited by 339 articles

See all "Cited by" articles

Publication types

Feedback