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Lack of Adherence With the Analgesic Regimen: A Significant Barrier to Effective Cancer Pain Management

From the Schools of Nursing, Medicine, and Pharmacy, University of California, San Francisco, CA, and School of Nursing, University of Pennsylvania, Philadelphia, PA.

Address reprint requests to Christine Miaskowski, RN, PhD, Department of Physiological Nursing, University of California, San Francisco, 2 Koret Way, Box 0610, Rm N 611Y, San Francisco, CA 94143-0610; email: chris.miaskowski{at}nursing.ucsf.edu

PURPOSE: To evaluate oncology outpatients’ level of adherence to their analgesic regimen during a 5-week period.

PATIENTS AND METHODS: A random sample of 65 adult oncology outpatients with a Karnofsky performance status score of 50, an average pain intensity score of 2.5, and radiographic evidence of bone metastasis were recruited for this longitudinal study from seven outpatient settings. On a daily basis, patients rated their level of pain intensity and recorded pain medication intake. Adherence rates for opioid analgesics prescribed on an around-the-clock (ATC) and on an as-needed (PRN) basis were calculated on a weekly basis.

RESULTS: Overall adherence rates for ATC opioid analgesics ranged from 84.5% to 90.8% and, for PRN analgesics, from 22.2% to 26.6%. No significant differences over time were found in either of these adherence rates.

CONCLUSION: One factor that seems to contribute to ineffective cancer pain management is poor adherence to the analgesic regimen.

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