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Background: Pain and neuropathic symptoms impact quality of life of patients with cancer. To obtain more insight in the prevalence, severity, and treatment of neuropathic symptoms in patients with cancer and their interference with daily activities, we conducted a cross-sectional study at the outpatient clinic of a Dutch university hospital., Methods: A cross-sectional study among outpatients with cancer. To identify pain, its intensity, quality, and interference with daily activities, the Brief Pain Inventory (BPI) was used. Neuropathic symptoms were identified with the Douleur Neuropathique (DN4) interview and pain characteristics with the McGill Pain Questionnaire (MPQ). Pain medication and adjuvant analgesics were also collected with a prestructured questionnaire. Descriptives, chi-squared tests, t-tests, and a logistic regression analysis were conducted., Results: 892 patients completed the questionnaires. Twenty-three percent (n = 204) reported moderate to severe pain, and 19% (n = 170) scored positive on neuropathic symptoms (DN4 ≥ 3). Particularly in patients with a rating on a numeric rating scale (NRS) < 5, existence of neuropathic symptoms significantly increased interference with daily activities. Of patients with neuropathic symptoms, 8% received adjuvant pain treatment. Receiving curative treatment, using a systemic drug with neurotoxicity, having had an operation, and having had a lymph node dissection independently contributed to having neuropathic symptoms., Conclusions: This study shows that over 40% of the patients with moderate to severe pain also have neuropathic symptoms, causing increased interference with daily activities. Most of these patients do not receive adjuvant analgesics. There is a need to improve management of neuropathic symptoms in patients with cancer., (© 2015 World Institute of Pain.)

Background: Pain assessment and monitoring is a prerequisite for its adequate treatment in patients with cancer. We performed a feasibility study on the use of short message service (SMS) and interactive voice response (IVR) to improve pain management in patients with cancer, including terminally ill patients., Methods: During 4 weeks, palliative patients received a daily IVR asking to provide their pain score on a numeric rating scale (NRS) with their mobile phone. If pain was moderate or high, the nurse contacted the patient the same day and, if required, adapted the treatment., Results: Thirteen of the 17 invited patients agreed to participate (79%), four died during the study period. IVR/SMS provides a reliable assessment of the pain intensity, and if required, treatment can be rapidly adapted. All patients were satisfied with the intervention. There were no difficulties for the, mainly older, patients in handling this communication way on pain intensity. The mean pain score decreased from 4.78 to 3.33 (P = 0.07). The pain scale of the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30) decreased significantly from 56 to 35 (P = 0.047)., Discussion: Monitoring and managing pain with IVR/SMS in patients with cancer at home appeared acceptable and feasible, even in terminally ill patients. The reluctance for actively contacting the professional in case of increased pain intensity is circumvented in this setting. Further research, preferably in a controlled study, is needed to establish the use of this intervention in a larger patient population., (© 2015 World Institute of Pain.)

Background: Systematic pain registration and assessment with a visual analog scale (VAS) or numeric rating scale (NRS) at each visit are key recommendations in one of the most recent guidelines on cancer pain management. It is unclear whether this recommendation is applied., Objectives: The aim was to explore registration of pain in medical records of patients visiting the medical oncology outpatient clinic., Methods: In a multicenter study in six Dutch hospitals, data were extracted from medical records of 380 outpatients with cancer. Data of the first three visits at the outpatient clinic were studied. Descriptive statistics were conducted., Results: In 23% of all 987 visits at the outpatient clinic, pain or absence of pain was registered, and in an additional 15%, a nonspecific symptom description was given. Regarding all other visits, (62%) pain or absence of pain was not documented at all. Pain measurement using a VAS or NRS was documented in only one visit. Pain was more often registered in medical records of patients with metastasis, as well as in those of patients with urogenital tumors., Conclusion: Pain in medical oncology outpatients is not systematically registered in their medical records. With one exception, pain was not registered with a VAS or NRS. Yet, registration and assessment of pain to monitor pain are essential to evaluate and adapt pain treatment over time. Pain registration has not improved since 2001 and therefore implementing the recommendations regarding systematic monitoring of pain is needed., (© 2014 World Institute of Pain.)

Objective: More than 50% of patients with cancer experience pain. Patient empowerment has been highlighted as central to success in pain management. Up to now, no clear model for this patient group exists, yet several strategies to empower patients have been used in clinical practice. This review examines how empowerment or related concepts have been described in relation to pain management in patients with cancer. With the help of a conceptual model, recommendations for clinical practice are provided., Methods: An integrative review was conducted, using the databases PubMed, CINAHL and PsycINFO. We evaluated papers discussing empowerment or related concepts in relation to pain management in patients with cancer. We analyzed the term 'empowerment' semantically., Results: From a total of 5984 identified papers, 34 were included for analysis. Empowerment has been described with the concepts self-efficacy, active patient participation, increasing abilities, and control of life. Most papers focus on pain treatment induced by the professional caregiver or on the active involvement of the patient, and not on the combination of both. The following elements of empowerment could be discriminated: role of the patient, role of the professional, resources, self-efficacy, active coping, and shared decision making., Conclusions: On the basis of these findings, we propose a conceptual model to empower patients in controlling cancer pain. We recommend focusing on pain treatment given by the professional, on the active involvement of the patient, and on the interaction of both. Our model might also be useful for other patient groups or specific contexts, especially in symptom management., (Copyright © 2014 John Wiley & Sons, Ltd.)

Background: Pain prevalence at various stages of cancer ranges from 27% to 60% for outpatients. Yet, how pain is managed in this patient group is poorly understood., Objectives: The primary objective was to assess pain prevalence and intensity, and its interference with daily activities, in medical oncology outpatients. The secondary objectives were the adequacy of analgesic pain treatment and to identify independent predictors for moderate to severe pain., Study Design: A cross-sectional study., Setting: Oncology outpatient clinics of 7 Dutch regional hospitals., Methods: Four hundred twenty-eight medical oncology outpatients were assigned to the study. Pain prevalence and interference of pain with daily activities were assessed using the Brief Pain Inventory. Adequacy of analgesic treatment was determined by calculating the Pain Management Index (PMI). Descriptive statistics, non-parametric tests, and logistic regression analysis were conducted., Results: More than one third of all participants reported pain (39%). Eighty-three patients (20%) had moderate to severe pain (NRS 5-10). Analgesic treatment was inadequate in more than half of the patients with pain (62%). Interference of pain with daily activities increased with increased intensity, yet even 10%-33% of patients suffering mild pain reported high interference with daily activities. High current pain intensity and high interference with general daily activities predicted moderate to severe pain., Limitations: No characteristics of nonparticipants were available., Conclusion: Pain remains a significant problem in medical oncology outpatients, and often pain is insufficiently managed. Patients with a high pain intensity were more at risk to experience pain related interference with daily activities, but even some patients suffering mild pain experienced this. As adequate pain relief for up to 86% of the patients with cancer should be feasible, pain in medical oncology outpatients is still undertreated. Taking into account the interference of pain with daily activities and predictors of pain will facilitate cancer pain management. The study has been approved by the Medical Ethics Committee (CMO) in all 7 hospitals (METC protocol number 2011/020) and has been registered by the Dutch Trial register (NTR): NTR2739.

Background: One-half of patients with cancer have pain. In nearly one out of two cancer patients with pain, this was undertreated. Inadequate pain control still remains an important problem in this group of patients. Therefore, in 2008 a national, evidence-based multidisciplinary clinical practice guideline 'pain in patients with cancer' has been developed. Yet, publishing a guideline is not enough. Implementation is needed to improve pain management. An innovative implementation strategy, Short Message Service with Interactive Voice Response (SVS-IVR), has been developed and pilot tested. This study aims to evaluate on effectiveness of this strategy to improve pain reporting, pain measurement and adequate pain therapy. In addition, whether the active role of the patient and involvement of caregivers in pain management may change., Methods/design: A cluster randomised controlled trial with two arms will be performed in six oncology outpatient clinics of hospitals in the Southeastern region of the Netherlands, with three hospitals in the intervention and three in the control condition. Follow-up measurements will be conducted in all hospitals to study the long-term effect of the intervention. The intervention includes training of professionals (medical oncologists, nurses, and general practitioners) and SMS-IVR to report pain in patients with cancer to improve pain reporting by patients, pain management by medical oncologists, nurses, and general practitioners, and decrease pain intensity., Discussion: This innovative implementation strategy with technical tools and the involvement of patients, may enhance the use of the guideline 'pain in patients with cancer' for pain management. Short Message Service alerts may serve as a tool to support self-management of patients. Therefore, the SMS-IVR intervention may increase the feeling of having control over one's life., Trial Registration: [corrected] Netherlands Trial Register (NTR): NTR2739., (© 2011 te Boveldt et al; licensee BioMed Central Ltd.)